Interspinous Oedema

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There are a variable number of bursae in the spinal column. They are normally located between the spinous processes of the cervical and lumbar segments. Bursitis of these structures can result in neck or back pain. In the neck, interspinous bursitis has been associated with several rheumatological conditions such as polymyalgia rheumatica, rheumatoid arthritis, and crystalopathies. In the lumbar spine the condition is also known as "kissing-spine" or Baastrup's disease and occurs in the context of degenerative change.

Kissing Spines

This condition, also known as Baastrup's disease, arises due to excessive lumbar lordosis, or following extension injuries to the lumbar spine. The adjacent spinous processes, the most common level being L4/5, compresses the intervening interspinous ligament. It is more common in the degenerative lumbar spine in those aged 70 and older with changes occuring in the context of disc height loss, spondylolisthesis, and spondylosis. Patients may have midline back pain that worsens with extension and relieved by flexion, with symptoms exaggerated with finger pressure at the suspected level.

Bogduk theorises that the pain arises as a result of a periostitis of the spinous processes, or inflammation of the interspinous ligament. The periosteum of the spinous processes and the interspinous spaces are innervated by the medial branches of the lumbar dorsal rami. Surgical excision is usually not successful in reducing pain in the context of kissing spines.

An open access review is available by Filippiadis et al.

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