What is the Kissing Spine Disease?
Kissing spine disease, formally known as Baastrup syndrome, is a medical condition characterized by low back pain resulting from the spinous processes of adjacent vertebrae in the spine rubbing against each other. This friction leads to a range of degenerative changes in the bones and soft tissues, often accompanied by inflammation of the bursa located between these bony projections.
Understanding Baastrup Syndrome
At its core, Baastrup syndrome, or kissing spine disease, occurs when the bony protrusions (spinous processes) at the back of the vertebrae, particularly in the lumbar spine, are too close and make contact. This constant rubbing creates friction, leading to a localized inflammatory condition known as interspinous bursitis. Over time, this chronic irritation can cause various degenerative changes, including:
- Bone sclerosis: Hardening of the bone.
- Osteophyte formation: Growth of new bone spurs.
- Cyst formation: Fluid-filled sacs.
- Erosion: Wearing away of the bone surfaces.
These changes contribute to the narrowing of the space between the spinous processes, further exacerbating the "kissing" effect and the resulting pain.
Common Symptoms
The primary symptom of kissing spine disease is localized low back pain. However, the specific characteristics of the pain can vary:
- Location: Typically felt in the midline of the lower back.
- Aggravation: Pain often worsens with activities that involve extending the spine (bending backward), prolonged standing, or walking.
- Relief: Pain usually improves with spinal flexion (bending forward) or sitting.
- Tenderness: The affected area may be tender to the touch.
- Referred pain: In some cases, pain might radiate to the buttocks or thighs, though this is less common than with nerve compression issues.
Causes and Risk Factors
Baastrup syndrome is primarily an age-related degenerative condition, meaning it tends to develop over time due to wear and tear on the spine. Key factors contributing to its development include:
- Degenerative changes: Natural aging processes lead to disc space narrowing and altered spinal mechanics, bringing spinous processes closer.
- Postural habits: Prolonged lordosis (excessive inward curve of the lower back) can increase the likelihood of contact.
- Repetitive movements: Activities that repeatedly extend the spine.
- Trauma: Previous injuries to the spine.
Diagnosis
Diagnosing kissing spine disease typically involves a combination of:
- Clinical examination: A physical assessment where the doctor checks for tenderness and evaluates pain with spinal movements.
- Imaging studies:
- X-rays: Can show the close proximity or contact of the spinous processes and signs of degenerative changes like sclerosis.
- MRI (Magnetic Resonance Imaging): Provides detailed images of soft tissues, allowing for the visualization of interspinous bursitis and other soft tissue changes.
- CT scan: Can provide more detailed bone imaging.
- Diagnostic injection: Injecting a local anesthetic into the interspinous bursa; temporary pain relief can confirm the diagnosis.
Treatment Approaches
Treatment for kissing spine disease aims to alleviate pain, reduce inflammation, and improve spinal function. Approaches typically begin with conservative methods and may progress to more invasive options if necessary.
Conservative Management
- Rest and activity modification: Avoiding activities that worsen pain, especially spinal extension.
- Physical therapy:
- Exercises to strengthen core muscles and improve posture.
- Stretching to increase spinal mobility in flexion.
- Manual therapy techniques.
- Medications:
- Over-the-counter pain relievers (NSAIDs like ibuprofen).
- Prescription pain medications if needed.
- Epidural steroid injections: Injections of corticosteroids directly into the interspinous space can help reduce inflammation and pain.
Minimally Invasive Procedures
- Radiofrequency ablation (RFA): Using heat to ablate the nerves supplying the affected area, providing longer-term pain relief.
Surgical Options
Surgery is rarely required for kissing spine disease and is typically considered only when conservative treatments have failed and pain significantly impacts daily life. Surgical procedures aim to decompress the area and prevent the spinous processes from rubbing.
- Spinous process osteotomy: Removing a portion of the offending spinous process.
- Interspinous device implantation: Inserting a spacer between the spinous processes to maintain separation.
By understanding the underlying mechanisms and available treatment options, individuals with kissing spine disease can effectively manage their symptoms and improve their quality of life.
