Baastrup disease

Close contact between neighbouring spinous processes, sometimes associated with midline pain worsened by extension.

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Understanding the mechanism

Baastrup disease describes close approximation of neighbouring spinous processes, sometimes with inflammation or bursitis between them. It is also called kissing spines and is usually described in the degenerative lumbar spine. Visible contact can nevertheless be incidental. A clinical relationship needs to be established before assuming that the imaging finding explains the person's pain.

Symptoms and warning signs

The typical presentation is midline pain increased by extension and sometimes eased by flexion. Local tenderness may be present but is not diagnostic on its own. Radiation or neurological loss can arise from associated lesions rather than the spinous contact itself. New neurological findings, fever or pain after trauma requires appropriate assessment instead of being labelled a routine Baastrup flare.

Diagnosis and investigations

Radiographs and CT describe bone changes. MRI can identify interspinous inflammation and investigate alternatives such as stenosis, disc disease or facet pathology. An isolated image does not justify an invasive procedure. Available studies describe anatomical associations but do not establish that every episode of central low-back pain arises from this particular condition.

Treatment and outlook

Modifying provoking movements and gradually restoring capacity may be reasonable for selected cases. Targeted injections are sometimes considered by specialists, while surgery is reserved for particular circumstances. Treatment evidence remains limited and heterogeneous. Defining a useful functional goal helps assess response, and a lack of improvement should prompt reconsideration of the diagnosis rather than indefinite repetition of the same procedure.

The role of TAGMED care

At TAGMED, care depends on the examination and any associated lesions. Decompression cannot guarantee permanent separation of the spinous processes or elimination of bursitis. Direct percussion over a highly painful site may be unsuitable. Laser, shockwave and manual techniques do not have a universal indication for Baastrup disease; each requires a specific rationale and monitoring of benefit and adverse effects.

Practical follow-up

Identifying which extension activities actually cause difficulty helps adjust loading without creating fear of all movement. Reassessment can compare those tasks and daily participation. If the presentation changes, alternative spinal causes should be reconsidered rather than relying indefinitely on the original label.

Frequently asked questions

Is this a fracture?

The usual mechanism is degenerative, but pain after trauma still needs separate assessment.

Does kissing spines guarantee pain?

No. Anatomical approximation can exist without being the main source of symptoms.

Should every extension movement be avoided?

Movements are adjusted to tolerance and findings rather than prohibited universally.

Is an injection always needed?

No. It requires specialist selection after a sufficiently coherent clinical attribution.

When should the explanation be reconsidered?

With atypical pain, a new deficit or failure to improve function.

Educational information from The Spine Page. This entry does not replace an individual assessment. Documentary version: October 12, 2026. Sylvain Desforges, B.Sc., D.O., N.D., osteopath and naturopath.