Clinical note
Interspinous Ligament Steroid Injections for the Management of Baastrup’s Disease: A Case Report

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Abstract

Mitra R, Ghazi U, Kirpalani D, Cheng I. Interspinous ligament steroid injections for the management of Baastrup’s disease: a case report.

Baastrup’s disease has been identified as a source of axial low back pain. There has been debate as to the etiology of pain in patients with Baastrup’s disease. It has been theorized that the pain may originate from degenerative disk disease and spinal stenosis associated with the disease, whereas some have identified the neoarthrosis between joints and accompanying reactive eburnation as the source of pain. We present a simple case report of an 89-year-old woman with symptomatic Baastrup’s disease. The patient underwent a fluoroscopically guided interspinous process injection of 20mg of triamcinolone acetate with local anesthetic. The patient remained pain free for 3 months. The neoarthrosis in Baastrup’s disease may be the primary pain generator in cases of Baastrup’s disease without significant central canal stenosis.

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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