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|LETTER TO EDITOR
|Year : 2014 | Volume
| Issue : 6 | Page : 711-712
An unusual cause of low backache: Lumbar interspinous bursitis
Mandeep Singh Ghuman1, Shabdeep Kaur2, Gagandeep Singh3, Kavita Saggar1
1 Department of Radiology, Dayanand Medical College and Hospital, Ludhiana, India
2 Department of Radiology, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India
3 Department of Neurology, Dayanand Medical College and Hospital, Ludhiana, India
|Date of Submission||07-Dec-2014|
|Date of Decision||08-Dec-2014|
|Date of Acceptance||08-Dec-2014|
|Date of Web Publication||16-Jan-2015|
Mandeep Singh Ghuman
Department of Radiology, Dayanand Medical College and Hospital, Ludhiana
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Ghuman MS, Kaur S, Singh G, Saggar K. An unusual cause of low backache: Lumbar interspinous bursitis. Neurol India 2014;62:711-2
A 52-year-old male presented with low back pain of considerable intensity. Pain was essentially localized to lower lumbar region and got exaggerated on spinal extension. There was no history suggestive of radiculopathy or claudication. Magnetic resonance imaging (MRI) of lumbo-sacral spine revealed inflammatory fluid-like hyperintense signal in the interspinous ligaments at L3-4 and L4-5 levels on short tau inversion recovery (STIR) images [Figure 1]a and b; consistent with interspinous bursitis.
|Figure 1: Magnetic resonance imaging (MRI) appearance of lumbar interspinous bursitis (Baastrup disease). Sagittal short tau inversion recovery (STIR) images (a and b) nicely depicts the fluid - like high signal in the closely apposing interspinous ligaments at L3 - 4 and L4 - 5 levels suggestive of bursitis. Apart from mild disc bulge and disc dessiction at L4-5 level, no significant discal herniation or spinal canal compromise seen|
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Lumbar interspinous bursitis, also called Baastrup disease, is characterized by close approximation and contact of adjacent spinous processes (kissing spine) with resultant enlargement, flattening, reactive sclerosis of apposing interspinous surfaces forming neo-articulation. , Repetitive strain on the interspinous ligaments is thought to lead to degeneration and collapse of the ligaments, allowing contact between adjacent spinous processes. Genesis of pain may be due to irritation of the periosteum or adventitial bursae between abutting spinous processes. 
Commonly seen in older population having hyperlordosis and associated degenerative disc disease, it can manifest clinically as midline localized lumbar pain and/or tenderness that increases in severity on back extension and get relieved by flexion. , Rarely, it can cause neurogenic claudication and spinal canal stenosis if fluid extends up to posterior epidural space.  Spinous process fractures has also been reported in Baastrup disease. 
Various treatment options like local site injections of anesthetic agents or steroids and excision of part of the spinous processes has been described for this condition.  Surgical treatment has not been shown to be effective in presumptively diagnosed Baastrup disease. 
In usual practice, imaging personnel and clinicians focus more on anterior column processes; posterior elements, and posterior soft tissues are often neglected or not mentioned in the radiology reports too.  As lumbar spine MRI is very common investigation, lumbar interspinous bursitis although uncommon, can be encountered in routine clinical practice. Clinicians and radiologists should be aware of this entity and interspinous hyperintense signal should not be misinterpreted for other more sinister pathologies such as infections or neoplasms which will unnecessarily prompt further invasive investigations. 
| » References|| |
Ho L, Wassef H, Seto J, Henderson R. Multi-level lumbar Baastrup disease on F-18 FDG PET-CT. Clin Nucl Med 2009;34:896-7.
Pinto PS, Boutin RD, Resnick D. Spinous process fractures associated with Baastrup disease. Clin Imaging 2004;28:219-22.
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:E211-5.