Baastrup's Disease in Pediatric Gymnasts

Abstract

Baastrup's disease is a rare, often misdiagnosed, and causes back pain in children. It is characterized by degenerative changes of both spinous processes and interspinous soft tissues between two adjacent vertebrae. Repetitive spinal movements in the sagittal plane predispose injury to posterior elements of the spine. Chronic flexion and extension strain the interspinous ligament, causing the neighboring spinous processes to adjoin. Patients typically report midline back pain in the lumbar region, which radiates both cephalad and caudad but not laterally. Pain is aggravated by extension and palpation and is alleviated with flexion. Some children with Baastrup's do not experience pain but present with swelling along the spinous processes. Diagnosis is dependent on distinctive radiologic findings and exam features. Increased interspinous spaces and bone remodeling may be observed. While the current treatment for pain associated with Baastrup's is directed towards physical therapy, massage therapy, nonsteroidal anti-inflammatory medications, muscle relaxants, and rest from activity, this is the first report of children undergoing interventional modalities for the treatment of back pain associated with Baastrup's disease. We present two unique pediatric cases of female gymnasts with Baastrup's disease who were successfully treated by two different techniques: interspinous ligament injection and medial branch block.

Keywords: Baastrup’s; back pain; gymnast; kissing spine; local anesthetics; pain management; peripheral nerve block; physical functioning impairment.

Figure 1

(a) Magnetic resonance imaging (MRI) thoracic spine sagittal view shows an arrow pointing to signal abnormality at the tips of the spinous processes in the thoracolumbar junction region, particularly at T12. (b) MRI lumbar spine axial view shows an arrow pointing at mild hyperintensity in the T12 spinous process.

Figure 2

(a) Magnetic resonance imaging (MRI) lumbar spine sagittal view shows an arrow pointing to a small focal area of soft tissue edema along the L3 spinous process into the L2-3 interspinous ligament without underlying bone marrow edema, compatible with the earliest findings of "kissing spine" Baastrup’s disease. (b) MRI lumbar spine coronal view shows an arrow pointing to a small focal area of soft tissue edema along the L3 spinous process.