Baastrup's sign

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Baastrup's sign
Other namesKissing spine
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A diagram of a human vertebral body. With Baastrup's sign, the posterior spinous process, pointing down and to the left, is abnormally thickened due to repetitive microtrauma.
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Baastrup's sign is an orthopedic and radiographic disorder that often occurs in elderly humans. It is characterized by enlargement of the posterior spinous processes of the lumbar spine, with normal intervertebral disc height and neuroforamina. The reason it is referred to as kissing spine is because the posterior spinous processes 'kiss' and touch one another as the individual goes into lumbar extension, for example when flat on their stomach. [1] [2] The condition has been seen in humans, canines, particularly with boxer breeds, [3] and certain breeds of horses. [4] This disorder is named after Christian Ingerslev Baastrup.

Contents

Diagnosis

Sagittal CT of the lumbar spine showing Baastrup's sign. Baastrup CT sagittal.png
Sagittal CT of the lumbar spine showing Baastrup's sign.

The salient feature of the disorder is the exuberant osteophytosis that occurs at posterior lumbar spinous processes. Osteophytes are coarse calcifications at the edges of bone that form due to repetitive stress and trauma. There is also atrophy and fatty replacement of paraspinal musculature, which can be detected by CT or MRI. [5]

Treatment

The malpositioning seen on radiography may not cause any symptoms at all. If there are related symptoms, however, therapeutic options include chiropractic care, physical therapy and nerve block injections. As a last resort, decompressive laminectomy may be attempted to relieve pain symptoms and remove the abnormally enlarged portions of bone. [6]

Related Research Articles

Sacrum Triangular-shaped bone at the bottom of the spine

The sacrum, in human anatomy, is a large, triangular bone at the base of the spine that forms by the fusing of the sacral vertebrae (S1–S5) between ages 18 and 30.

Lumbar vertebrae Five vertebrae between the pelvis and the rib cage

The lumbar vertebrae are, in human anatomy, the five vertebrae between the rib cage and the pelvis. They are the largest segments of the vertebral column and are characterized by the absence of the foramen transversarium within the transverse process and by the absence of facets on the sides of the body. They are designated L1 to L5, starting at the top. The lumbar vertebrae help support the weight of the body, and permit movement.

Lumbar spinal stenosis Medical condition of the spine

Lumbar spinal stenosis (LSS) is a medical condition in which the spinal canal narrows and compresses the nerves and blood vessels at the level of the lumbar vertebrae. Spinal stenosis may also affect the cervical or thoracic region, in which case it is known as cervical spinal stenosis or thoracic spinal stenosis. Lumbar spinal stenosis can cause pain in the low back or buttocks, abnormal sensations, and the absence of sensation (numbness) in the legs, thighs, feet, or buttocks, or loss of bladder and bowel control.

Laminectomy

A laminectomy is a surgical procedure that removes a portion of a vertebra called the lamina, which is the roof of the spinal canal. It is a major spine operation with residual scar tissue and may result in postlaminectomy syndrome. Depending on the problem, more conservative treatments may be viable.

Cervical spine disorder Medical condition

Cervical spine disorders are illnesses that affect the cervical spine, which is made up of the upper first seven vertebrae, encasing and shielding the spinal cord. This fragment of the spine starts from the region above the shoulder blades and ends by supporting and connecting the skull.

Lordosis Medical condition

Lordosis is historically defined as an abnormal inward curvature of the lumbar spine. However, the terms lordosis and lordotic are also used to refer to the normal inward curvature of the lumbar and cervical regions of the human spine. Similarly, kyphosis historically refers to abnormal convex curvature of the spine. The normal outward (convex) curvature in the thoracic and sacral regions is also termed kyphosis or kyphotic. The term comes from the Greek lordōsis, from lordos.

Cervical vertebrae Vertebrae of the neck

In tetrapods, cervical vertebrae are the vertebrae of the neck, immediately below the skull. Truncal vertebrae lie caudal of cervical vertebrae. In sauropsid species, the cervical vertebrae bear cervical ribs. In lizards and saurischian dinosaurs, the cervical ribs are large; in birds, they are small and completely fused to the vertebrae. The vertebral transverse processes of mammals are homologous to the cervical ribs of other amniotes. Most mammals have seven cervical vertebrae, with the only three known exceptions being the manatee with six, the two-toed sloth with five or six, and the three-toed sloth with nine.

Degenerative disc disease Medical condition

Degenerative disc disease (DDD) is a medical condition in which there are anatomic changes and a loss of function of varying degrees of one or more intervertebral discs of the spine of sufficient magnitude as to cause symptoms. The root cause is thought to be loss of soluble proteins within the fluid contained in the disc with resultant reduction of the oncotic pressure, which in turn causes loss of fluid volume. Normal downward forces cause the affected disc to lose height, and the distance between vertebrae is reduced. The anulus fibrosus, the rigid outer shell of a disc, also weakens. This loss of height causes laxity of the longitudinal ligaments, which may allow anterior, posterior, or lateral shifting of the vertebral bodies, causing facet joint malalignment and arthritis; scoliosis; cervical hyperlordosis; thoracic hyperkyphosis; lumbar hyperlordosis; narrowing of the space available for the spinal tract within the vertebra ; or narrowing of the space through which a spinal nerve exits with resultant inflammation and impingement of a spinal nerve, causing a radiculopathy.

Spondylolisthesis Medical condition

Spondylolisthesis is the displacement of one spinal vertebra compared to another. While some medical dictionaries define spondylolisthesis specifically as the forward or anterior displacement of a vertebra over the vertebra inferior to it, it is often defined in medical textbooks as displacement in any direction. Spondylolisthesis is graded based upon the degree of slippage of one vertebral body relative to the subsequent adjacent vertebral body. Spondylolisthesis is classified as one of the six major etiologies: degenerative, traumatic, dysplastic, isthmic, pathologic, or post-surgical. Spondylolisthesis most commonly occurs in the lumbar spine, primarily at the L5-S1 level with the L5 vertebral body anteriorly translating over the S1 vertebral body.

Multifidus muscle Muscle in the back

The multifidusmuscle consists of a number of fleshy and tendinous fasciculi, which fill up the groove on either side of the spinous processes of the vertebrae, from the sacrum to the axis. While very thin, the Multifidus muscle plays an important role in stabilizing the joints within the spine. The multifidus is one of the transversospinales.

Spondylolysis Medical condition

Spondylolysis (spon-dee-low-lye-sis) is defined as a defect or stress fracture in the pars interarticularis of the vertebral arch. The vast majority of cases occur in the lower lumbar vertebrae (L5), but spondylolysis may also occur in the cervical vertebrae.

Radiculopathy Medical condition

Radiculopathy, also commonly referred to as pinched nerve, refers to a set of conditions in which one or more nerves are affected and do not work properly. Radiculopathy can result in pain, weakness, numbness, or difficulty controlling specific muscles. Pinched nerves arise when surrounding bone or tissue, such as cartilage, muscles or tendons, put pressure on the nerve and disrupt its function.

Laminotomy

A laminotomy is an orthopaedic neurosurgical procedure that removes part of the lamina of a vertebral arch in order to relieve pressure in the vertebral canal. A laminotomy is less invasive than conventional vertebral column surgery techniques, such as laminectomy because it leaves more ligaments and muscles attached to the vertebral column intact and it requires removing less bone from the vertebra. As a result, laminotomies typically have a faster recovery time and result in fewer postoperative complications. Nevertheless, possible risks can occur during or after the procedure like infection, hematomas, and dural tears. Laminotomies are commonly performed as treatment for lumbar spinal stenosis and herniated disks. MRI and CT scans are often used pre- and post surgery to determine if the procedure was successful.

Accessory bone Additional bone found in some people

An accessory bone or supernumerary bone is a bone that is not normally present in the body, but can be found as a variant in a significant number of people. It poses a risk of being misdiagnosed as bone fractures on radiography.

Facet syndrome Medical condition

Facet syndrome is a syndrome in which the facet joints cause painful symptoms. In conjunction with degenerative disc disease, a distinct but functionally related condition, facet arthropathy is believed to be one of the most common causes of lower back pain.

Spinal disease

Spinal disease refers to a condition impairing the backbone. These include various diseases of the back or spine ("dorso-"), such as kyphosis. Dorsalgia refers to back pain. Some other spinal diseases include spinal muscular atrophy, ankylosing spondylitis, lumbar spinal stenosis, spina bifida, spinal tumors, osteoporosis and cauda equina syndrome.

Myelomalacia Medical condition

Myelomalacia is a pathological term referring to the softening of the spinal cord. Possible causes of myelomalacia include cervical myelopathy, hemorrhagic infarction, or acute injury, such as that caused by intervertebral disc extrusion.

Spinal stenosis Disease of the bony spine that results in narrowing of the spinal canal

Spinal stenosis is an abnormal narrowing of the spinal canal or neural foramen that results in pressure on the spinal cord or nerve roots. Symptoms may include pain, numbness, or weakness in the arms or legs. Symptoms are typically gradual in onset and improve with bending forwards. Severe symptoms may include loss of bladder control, loss of bowel control, or sexual dysfunction.

Vertebral column Bony structure found in vertebrates

The vertebral column, also known as the backbone or spine, is part of the axial skeleton. The vertebral column is the defining characteristic of a vertebrate in which the notochord found in all chordates has been replaced by a segmented series of bone: vertebrae separated by intervertebral discs. The vertebral column houses the spinal canal, a cavity that encloses and protects the spinal cord.

Vertebra Bone in the vertebral column

In the vertebrate spinal column, each vertebra is an irregular bone with a complex structure composed of bone and some hyaline cartilage, the proportions of which vary according to the segment of the backbone and the species of vertebrate.

References

  1. "Who named it - Baastrup's sign".
  2. Lin, E. (2008). "Baastrup's disease (kissing spine) demonstrated by FDG PET/CT". Skeletal Radiology. 37 (2): 173–175. doi:10.1007/s00256-007-0379-2. PMID   18087748. S2CID   1317481.
  3. "Medical Dictionary Online - Baastrup's".
  4. "Horse and Hound: Explaining kissing spines".
  5. Haig, A.; Harris, A.; Quint, D. (2001). "Baastrup's disease correlating with diffuse lumbar paraspinal atrophy: a case report". Archives of Physical Medicine and Rehabilitation. 82 (2): 250–252. doi:10.1053/apmr.2001.18052. PMID   11239319.
  6. "Baastrup's Disease - General Practice Notebook".
Classification
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