Kissing spine syndrome – Baastrup’s disease

In the article and video below we describe the problems, diagnosis and treatment of Kissing spines syndrome or Baastrup’s disease.

An August 2021 paper in the Journal of neurosurgical sciences (1) describes Baastrup disease as a common cause of low back pain which is often underdiagnosed. It is characterized by adjacent interspinous processes contact and it can be associated with cystic lesions (which can cause pressure and impingement on the spinal nerves). The purpose of this paper according to the researchers was to “evaluate the epidemiology, diagnosis, and treatment options of patients with Baastrup disease.”

In a review of previously published research, the study authors included the cases of 1308 patients. The average age the patients was 59.6 years old. There were 13 men for every 10 women in this study.

Diagnosis in these patients were based on standard and dynamic flexion-extension radiographs of the lumbar spine in 213 (16.2%) of the cases.
MRI was performed in 735 patients (56,2%) whereas fluorodeoxyglucose (FDG)-positron emission tomography (PET)/CT was used to demonstrate Baastrup disease in 77 included cases (5.9%).
CT scan was performed in 574 cases (43.9%).

In research that included treatment options, the researchers found the treatment choice in 277 patients were as follows:

Anti-inflammatory drugs and physical therapy were chosen in 99 cases (35.7%).
Percutaneous infiltrations (painkillers and steroids) in 80 (28.9%) and surgical decompression in 196 (70.7%) patients.

A significant problem with Baastrup’s disease is the diagnosis.

A significant problem with Baastrup’s disease is the diagnosis. We see this problem discussed frequently in the medical literature. In 2015 doctors (2) presented a case history of a 56-year-old man who had suffered for ten years from progressive mechanical back pain. It became worse on prolonged erect stranding and spine extension and improved when he assumed the fetal position. His lumbar spine radiography revealed enlargement and sclerosis of the spinous processes which was confirmed by computed tomography, suggesting Baastrup’s disease. The case authors noted that the tens years of degenerative disease the patient suffered from was in part because of the lack of understanding as to what was causing his problems: “Radiographically, spinous process impingement leads to reactive sclerosis, enlargement, flattening, and remodeling of the involved vertebral spines. Physicians frequently miss it on radiographs due to lack of knowledge and overexposure of spinous processes in most X rays. . .Baastrup’s disease should be considered in differential diagnosis of back pain, although one must be aware the typical radiographic changes appear to be common with aging and may not be the cause of patient’s symptoms.”

A similar case was presented in 2016 in the medical journal Curēus (3). Here doctors noted: “Though fairly common, Baastrup’s disease is overwhelmingly underdiagnosed and often missed due to a lack of knowledge and/or improper diagnostic techniques, leading to frequent mistreatment.” To demonstrate this point, the authors presented a case of a 56-year-old man who presented with chronic, ongoing low back pain of several years duration. His pain was relieved by flexion of the spine, and aggravated by extension. Imaging studies revealed “kissing” posterior spinous processes, consistent with a diagnosis of Baastrup’s Disease. He was treated with subcutaneous steroid injections and showed considerable clinical improvement.”

CTs and MRIs can see spinal ligament damage

A 2017 paper (4) reminded doctors that Baastrup’s disease or “kissing spines syndrome” was first described as a cause of lumbar pain before computerized tomography (CT) and magnetic resonance imaging (MRI) scanning existed. That the diagnosis was based on x-ray studies, which showed that the spinous processes, especially in the lower lumbar spine, moved close to each other and “kissed.” This was a generator of positional back pain.

Further, that it is the stretching, laxity, or weakness of the spinal ligaments, specifically, the interspinous and supraspinous ligaments that are degenerated in Baastrup’s disease and normally contributes significantly to sagittal alignment. The doctors write Ligamentous (damaged ligament causing) lumbar stenosis and anterolisthesis would be the expected pathology with deterioration of these ligaments. Further, ligament damage could be initially described on CT and MRI in patients with symptoms similar to Baastrup’s disease.

Why would someone get Kissing spines syndrome – Baastrup’s disease?

The correlation is most common between hyperlordosis that was not diagnosed. In our patient Joef, he did have hyperlordosis in his lower cervical spine that was due to muscle and ligament weakness, hypermobility and poor spinal curvature. Overtime the C6 and C7 compressed and came together posteriorly which injures and irritates the interspinous ligament and also causes an inflammatory cascade in that area. Every time he would start a motion requiring an upward arm movement, it would affect that C6 to C7 and he would get a terrible pain and a motion that would cause his ribs almost sublux forward anteriorly in order to accommodate and get around the problem that his C6 and C7 we’re not moving as they are supposed to.

With Kissing spines syndrome – Baastrup’s disease, the most common treatments that you would be recommended at a traditional medical office would be a steroid injection and then potentially radiofrequency ablation. If those treatments don’t work, physical therapy would be tried. If that failed, then surgery to remove a portion or the entirety of the spinous process would be recommended. When you remove the spinous process, you do compromise the integrity of the supporting ligaments and musculature as well.

Video summary transcript.

This is a Caring Medical patient named Joef. Joef has a very interesting case with us that we wanted to share with you.

Joef: The main reason I came to Caring Medical was that I had extreme brain fog and a tight pain in the chest. Every time I raised my arm I feel that (my chest) would roll (the ribs were in motion and causing discomfort). Joef describes what we did to try to resolve that issue.

When I would get that rolling motion I would keep my elbow tight to my body, it’s the only thing that would help my ribs from not rolling and making sounds and popping. I would also try to line myself up against the door and try to adjust my posture. That would help a little but not long-term.

Dr. Hutchinson and Joef explains the first visit:

This was such as interesting case. On the first day we took images with the Digital Motion X-ray machine so we could better assess what was going on. Especially understanding the co-symptom of brain fog so a look at Joef’s neck was judged to be useful. Eventually in the Digital Motion X-ray it was revealed that Joef had issues at C6-C7, the vertebrae were “clustered up”.

Joef has hypermobility his neck bones move much more than the average person. Initially it was thought a traction device would help correct his neck problems. But this was not the case. The gentle traction would cause his bones to move too much. It was determined via the Digital Motion X-ray that Joef’s C6 and C7 spinous process were in Kissing Spine Syndrome. What we did was under fluoroscopy was to flex Joef’s neck.

In this image from the video, the C6 and C7 spinous are kissing.

After treatment

Please note: Results may not be typical. This is one case. Not every patient will achieve similar results. The results achieved below were achieved with instrumented manipulation. Joef achieved near total elimination of his symptoms.

In this case report we were primarily moving the C5 bone anterior (forward) as it was evident that C5 was in a position posterior (behind) in relation to the C6. Not demonstrated in the video was a similar treatment / adustment to open space between the C6 and C7.

Dynamic Structural Medicine

The caption of this image reads: Dynamic Structural Medicine: Bony alignment, spinal curves and postures, as well as joint instability are the pillars of dynamic structural medicine. The effects of normal structural alignment and stability and the effects of malalignments, dysfunctional curves and joint instability explain the structural cause of human health and disease. Below the image is the explanatory concepts of Dynamic Structural Medicine.

The concept that subtle changes in cervical and spinal curvature, posture, and stability can impact and create problems that are neurologic, cardiovascular, gastroenterology, immunologic, and endocrine-like in nature. Without normal spinal alignment and movement, neurologic structures that travel through the neck are at risk.

References:

1 Meluzio MC, Smakaj A, Perna A, Velluto C, Grillo G, Proietti L, Martino DE, Tamburrelli FC. Epidemiology, diagnosis and management of Baastrup’s diseases: a systematic review. Journal of Neurosurgical Sciences. 2021 Aug 3. [Google Scholar]
2 Farinha F, Raínho C, Cunha I, et al. Baastrup’s Disease: a poorly recognised cause of back pain. Acta Reumatologica Portuguesa. 2015 Jul 1;40(3):302-3. [Google Scholar]
3 Philipp LR, Baum GR, Grossberg JA, Ahmad FU. Baastrup’s disease: an often missed etiology for back pain. Cureus. 2016 Jan 22;8(1). [Google Scholar]
4 Hatgis J, Granville M, Jacobson RE. Baastrup’s disease, interspinal bursitis, and dorsal epidural cysts: Radiologic evaluation and impact on treatment options. Cureus. 2017 Jul 9;9(7). [Google Scholar]