Clinical noteInterspinous Ligament Steroid Injections for the Management of Baastrup’s Disease: A Case Report
Section snippets
Case Description
An 89-year-old woman with a history of Baastrup’s disease, heart disease, bleeding peptic ulcer, and osteoperosis presented with a chronic history of axial LBP in the setting of lumbar spondylosis and T12-L1 vertebral body compression fracture. She had been treated with a variety of pain interventions including T12-L1 vertebroplasty, lumbar epidural steroid injection, lumbar facet intra-articular steroid injection, radiofrequency lesioning of the lumbar medial branch nerves, and nucleoplasty
Discussion
The differential diagnosis for axial LBP includes lumbar strain, lumbar facet joint arthropathy, central canal stenosis, diskogenic pain, spondylolithesis, paracentral disk herniation, lumbar spondylosis, vertebral compression fracture, and Baastrup’s disease. Our patient may have had a component of lumbar strain; however, she did not have any tenderness with deep palpation of the lumbar extensor muscles, piriformis muscle, or hip abductors. Despite the lack of any evidence of central canal or
Conclusions
Our case suggests that the pain generator in Baastrup’s disease was in fact the neoarthrosis between adjacent spinous processes. Reactive eburnation and abnormal uptake have been shown in patients with Baastrup’s on single photon-emission computed tomography bone scintigraphy and would explain the significant pain relief experienced by our patient after steroid injection.13 This case, however, may not be representative of all Baastrup’s disease patients because some have been reported to have
Acknowledgment
We thank Jackie Guingona for her assistance with the manuscript.
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