Disclosures: Robert J. Maldonado, MD: No financial relationships or conflicts of interest

Case Description: A 61-year-old female presented with midline, non-radiating lower back pain. The pain started insidiously without inciting injury. Pain was worse with activity, prolonged standing, and extension of the lumbar spine. There was no numbness, tingling, weakness, or incontinence. Physical exam was significant for tenderness to palpation of the lower lumbar spinous processes, and pain with lumbar spine extension. Her pain persisted despite activity modification and physical therapy. X-rays of the lumbar spine showed Baastrup’s Disease of the lower lumbar spinous processes. MRI did not show any significant central canal or neuroforaminal stenosis. The patient underwent L4-L5 and L5-S1 ultrasound-guided interspinous ligament steroid injections for treatment of her symptoms. The injection was performed with the patient prone and the transducer midline in the sagittal plane, with identification of the spinous processes and interspinous ligament. Using an out-of-plane step-down approach, the interspinous ligament between the L4-L5 and L5-S1 spinous processes was injected with a combination of 40mg Depo-medrol and 1.5mL of 0.5% Bupivacaine at each level.

Setting: An outpatient clinic in a free-standing rehabilitation hospital.

Patient: A 62-year-old female with chronic axial lower back pain. Assessment/

Results: The injections provided near-complete relief of her axial lower back pain lasting about 4 months. This led to functional improvements in the patient’s mobility and activity tolerance. When the pain gradually returned, the patient underwent a repeat set of injections that again provided near-complete symptom relief and functional gains.

Discussion: While a fluoroscopic approach has been described in the literature, this is the first reported case, to our knowledge, of ultrasound-guided interspinous ligament steroid injections for the treatment of Baastrup’s Disease.

Conclusion: Ultrasound-guided interspinous ligament injections are a safe and accurate alternative method to treat symptoms related to Baastrup’s Disease.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/ultrasound-guided-interspinous-ligament-injections-for-treatment-of-baastrups-disease-a-case-report/