Baastrup’s disease: The kissing spine (2024)

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  • World J Clin Cases
  • v.2(2); 2014 Feb 16
  • PMC3936220

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Baastrup’s disease: The kissing spine (1)

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World J Clin Cases. 2014 Feb 16; 2(2): 45–47.

Published online 2014 Feb 16. doi:10.12998/wjcc.v2.i2.45

PMCID: PMC3936220

PMID: 24579072

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A 67-year-old male presented with a gradually progressive low back pain of 2 years duration. The patient was leading a retired life and there was no history of chronic fever or significant trauma. There was no radiation of pain or any features suggestive of claudication. There was no history of any comorbidity. The pain was aggravated with extension of the spine and relieved with flexion. There was no swelling or neurological deficit, but muscle spasm was present. Radiographs of the spine revealed degenerative changes in the lumbosacral spine, along with articulation of spinous processes at in lumbar spine at all levels level suggestive of Baastrup’s disease, commonly known as “kissing spine”. Routine blood investigations were within normal limits. The patient was managed conservatively. He was given a week’s course of analgesics and muscle relaxants and then started on spinal flexion exercises, with significant improvement being noted at 6 months follow up.

Keywords: Baastrup’s disease, Neoarthrosis, Spinous process, Kissing spine, Osteophytes, Low back ache, Back pain

Core tip: Baastrup’s disease, although not a rare entity, is often misdiagnosed and wrongly treated due to poor knowledge. Complete evaluation and a detailed examination of radiographic images are crucial for a proper diagnosis and to avoid mismanagement of the condition, including a hasty surgical intervention.


Baastrup’s disease (kissing spine) is a relatively common entity characterized by degenerative changes of spinous processes and inter-spinous soft tissues. It involves the formation of hypertrophic spinous processes, an important cause of mechanical back pain, and accompanying degenerative disc disease. Most of the cases previously described in the literature were managed either surgically or with fluoroscopy image guided steroid injections. To the best of our knowledge, this is the first case showing significant improvement with only conservative management.


A 67-year-old male presented with gradually progressing low back pain of 2 years duration. The pain was aggravated with extension of the spine and relieved with flexion. There was no evidence suggestive of radiation of pain or any clinical features suggestive of claudication. The patient had no additional comorbidity. There was no history of chronic fever or significant trauma. Radiographs of the spine revealed degenerative changes involving the lumbosacral spine, along with articulation of spinous processes at at multiple levels level (Figure ​(Figure1),1), commonly known as “kissing spine” and strongly suggestive of Baastrup’s disease in the absence of any other features. The patient was managed conservatively with muscle relaxants and analgesics for one week and, once the pain subsided, was started on physiotherapy with spinal flexion exercises. The treatment plan involved conservative management with a close follow up. The option of intralesional steroid injections and bursal excision was to be considered if conservative treatment failed. The patient was monitored at the outpatient department at regular intervals and at 6 mo follow up was found to have significant improvement with physiotherapy alone and hence was asked to continue the exercises.

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Figure 1

Radiographs of lumbar spine in anterior-posterior and lateral views showing Baastrup’s disease at at multiple lumbar level.


This condition was first described as a neoarthrosis between adjacent spinous processes by Mayer[1]. Brailsford[2] demonstrated the same entity and labeled it “kissing spines”. Baastrup[3] described this condition again in detail and subsequently this condition came to be known as Baastrup’s disease. It was noted clinically in 6.3% of college athletes[4], most commonly gymnasts, and was thought to be related to the repetitive flexion and extension attributed to the sport. In a recent study by Kwong et al[5], Baastrup’s disease was found in 413 (41.0%) patients (diagnostic criteria being close approximation and contact between apposing spinous processes and sclerosis of the superior and inferior portions of adjacent processes on computed tomography) with an incidence of 81.3% among patients older than 80 years, whereas Maes et al[6] reported an overall incidence of 8.2% with the presence of a bursa between spinous process as a diagnostic criteria based on magnetic resonance imaging.

Two cohort studies have demonstrated conflicting reports of clinical improvement following surgical intervention. This included one early study of 10 patients by Franck[7] in 1944 in which the patients undergoing surgical excision of the spinous process for Baastrup’s disease demonstrated improvement. A later study by Beks et al[8] in 1989 in which 64 patients who underwent either partial or total surgical excision of the lumbar spinous processes demonstrated that surgery does not always alleviate the patient’s pain. Their research suggested that “kissing spine” might not be a disease entity itself but an additional pathology, specifically spondylosis with osteophyte formation. A case has been reported of atrophy and fatty replacement of the paraspinal musculature in a patient with Baastrup’s disease on X-ray[8]. Pain can be attributed to multiple factors in Baastrup’s disease, including mechanical pain secondary to the hypertrophic spinous processes coming into contact with each other, secondary to degenerative disc disease, and interspinous bursal fluid collections extending through the ligamentum flavum, leading to central canal stenosis[9]. In 2004, Pinto et al[10] reported 2 cases of spinous process fractures in patients with Baastrup’s disease and proposed that close proximity of the spinous processes resulted in its fracture and hence pain. Management includes decompression and posterior spinal instrumentation surgery or fluoroscopically guided interspinous steroid injections[11].

In conclusion, Baastrup’s disease is not a rare cause of back pain in the elderly but it is frequently missed on radiographs due to lack of knowledge about the disease on the part of physician and overexposure of spinous processes in most X rays. Most of the management suggested in the literature is invasive, i.e., surgery or intralesional injections. However, conservative management can also produce good results. Hence, it is imperative that the treating physician must attempt a conservative line of management before moving onto invasive modalities. Since this condition is one of the few treatable causes of back pain in the vast spectrum of spinal conditions, one must be aware of the condition to correctly diagnose and institute a line of treatment most beneficial to the patient.


Case characteristics

A 67-year-old male presented with a gradually progressive low back pain of 2 years duration.

Clinical diagnosis

Baastrup’s disease is not a rare cause of back pain in elderly, with pain aggravated on extension and relieved on bending forward.

Differential diagnosis

Common differential diagnoses include lumbar spondylosis, muscle strain, spondylolisthesis, fracture of the spinous process, vertebral compression fractures and infectious etiologies of the spine.

Imaging diagnosis

Radiographs showing articulation of spinous processes, i.e., the kissing spine.

Peer review

The authors present a nice case report.


P- Reviewers: Kutscha-Lissberg F, Serhan H S- Editor: Gou SX L- Editor: Roemmele A E- Editor: Wu HL


1. Mayer O. Ucber zwei neu entdeckte Gelenke an der Wirbelsäule des menschlichen Körpers. Z Physiol. 1825;2:29–35. [Google Scholar]

2. Brailsford JF. Deformities of the lumbo-sacral regions of the spine. Br J Surg. 1929;16:562–627. [Google Scholar]

3. Baastrup CL. On the spinous processes of the lumbar vertebrae and the soft tissue between them and on pathological changes in the region. Acta Radiol. 1933;14:52–54. [Google Scholar]

4. Mann DC, Keene JS, Drummond DS. Unusual causes of back pain in athletes. J Spinal Disord. 1991;4:337–343. [PubMed] [Google Scholar]

5. Kwong Y, Rao N, Latief K. MDCT findings in Baastrup disease: disease or normal feature of the aging spine? AJR Am J Roentgenol. 2011;196:1156–1159. [PubMed] [Google Scholar]

6. Maes R, Morrison WB, Parker L, Schweitzer ME, Carrino JA. Lumbar interspinous bursitis (Baastrup disease) in a symptomatic population: prevalence on magnetic resonance imaging. Spine (Phila Pa 1976) 2008;33:E211–E215. [PubMed] [Google Scholar]

7. Franck S. Surgical treatment of intraspinal osteoarthrosis (kissing spine) Acta Orthop Scand. 1944;14:127–152. [Google Scholar]

8. Beks JW. Kissing spines: fact or fancy? Acta Neurochir (Wien) 1989;100:134–135. [PubMed] [Google Scholar]

9. Chen CK, Yeh L, Resnick D, Lai PH, Liang HL, Pan HB, Yang CF. Intraspinal posterior epidural cysts associated with Baastrup’s disease: report of 10 patients. AJR Am J Roentgenol. 2004;182:191–194. [PubMed] [Google Scholar]

10. Pinto PS, Boutin RD, Resnick D. Spinous process fractures associated with Baastrup disease. Clin Imaging. 2004;28:219–222. [PubMed] [Google Scholar]

11. Mitra R, Ghazi U, Kirpalani D, Cheng I. Interspinous ligament steroid injections for the management of Baastrup’s disease: a case report. Arch Phys Med Rehabil. 2007;88:1353–1356. [PubMed] [Google Scholar]

Articles from World Journal of Clinical Cases are provided here courtesy of Baishideng Publishing Group Inc

Baastrup’s disease: The kissing spine (2024)


How serious is Baastrup's disease? ›

Patients with Baastrup's disease can have excessive lordosis with a resultant mechanical pressure that causes repetitive stress on the interspinous ligaments and adjacent spinous processes, which can lead to degeneration of the interspinous ligaments .

How do you treat Baastrup's syndrome? ›

Kissing spines is characterised by the close approximation and contact of adjoining spinous processes. It is often treated with injections as pain relief in the first instance. Physical therapy should include stretching and strengthening exercises to reduce the mechanical pressure on the spine and any hyperlordosis.

What is the success rate of kissing spine surgery? ›

Ideally, the horse will also have shown a positive response to nerve blocking. “That being said, surgical interventions for kissing spines disease have very good success rates,” says Dr. Davis. In fact, various studies have shown anywhere from 72 to 95 percent of horses return to full work after surgery.

What medication is used for kissing spine? ›

Generally I have found that treatment of the affected areas with injections using a combination of corticosteroids and Sarapin have been beneficial. In most cases that will be my first treatment and often done at the same time the radiographs are taken if the diagnosis is definitive.

Is Baastrup's disease curable? ›

Treating Baastrup Syndrome with Surgery

Surgery is typically the best longterm solution – especially if there is any nerve impingement involved. Using a minimally invasive keyhole procedure, a spine surgeon can clear up an pinched nerves, and rebuild the degenerative areas of the spine.

Can kissing spine be cured without surgery? ›

In mild cases horses might respond to conservative treatments such as muscle relaxants, chiropractic and acupuncture therapy, shock wave, or local corticosteroid injections. If a horse does not improve with conservative therapy or it's a more advanced case, the veterinarian might recommend surgery.

What are the symptoms of Baastrup's disease? ›

Clinically, patients with Baastrup's disease typically have midline pain, which radiates cephalad and caudad, that is increased with extension and alleviated with flexion. Pain can be reproduced with direct palpation of the pathologic interspinous ligament on physical exam.

How to fix a kissing spine? ›

One potential treatment method for kissing spines syndrome is chiropractic care. Through manipulations, stretches, and exercises, your chiropractor may be able to help you manage pain caused by both degenerative disc disease and kissing spine syndrome.

What is chronic Baastrup's disease? ›

Baastrup's disease is a relatively common disorder of the vertebral column, characterized by low back pain arising from the close approximation of adjacent posterior spinous processes and resultant degenerative changes, most commonly at L4-L5.

Is kissing spine surgery risky? ›

This surgery has an increased risk of infection and complications. After the surgery, remaining parts of the spinous processes can become sharp and irritated. Without proper rehab protocols, kissing spine can recur in other areas of your horse's back.

How long does it take to recover from kissing spine? ›

For those horses who undergo surgical procedures, recovery time may range from weeks to several months depending on the involvement of injury and method of treatment pursued. Stall rest followed by a very gradual and guided return to exercise is typically implemented.

What is the age limit for spinal surgery? ›

There's no formal age limit for spinal stenosis surgery. However, the younger a patient undergoes spinal surgery, the more likely they will require reoperation. Additionally, many elderly patients are at a high risk of complications from surgery.

Is kissing spine arthritis? ›

Kissing spines is also a form of osteoarthritis. The kissing spines are located at the top of the spine. In this condition, the spinal processes of two vertebrae touch each other. By touching the bone parts, a local irritation of the bone / cartilage occurs and new bone is created.

What does kissing spine feel like? ›

Common symptoms of kissing spines in horses include:

Back pain upon palpation. Reluctance to be saddled and/or girthed. Sensitivity to being brushed. Bucking or rearing under saddle.

What is the prognosis for degenerative spine disease? ›

Degenerative disc disease pain does not tend to progress with age. While the discs will often continue to degenerate, the associated pain tends to subside. Generally by age 60 a degenerated disc will have stabilized and will usually not be painful.

What are the symptoms of kissing spine disease? ›

Symptoms include back pain with midline distribution that worsens during extension, is relieved during flexion and is exaggerated upon finger pressure at the level of interest. Diagnosis rests on clinical examination and imaging studies.

What is the recovery time for kissing spine surgery? ›

For those horses who undergo surgical procedures, recovery time may range from weeks to several months depending on the involvement of injury and method of treatment pursued. Stall rest followed by a very gradual and guided return to exercise is typically implemented.

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