Kissing Spine (Baastrup's Disease): Surgical Options, Recovery, and Long-Term Outlook

What Type of Surgery Is Done for Kissing Spine?

Surgery for kissing spine, medically known as Baastrup's disease, primarily aims to alleviate symptoms by creating space between the abnormally close spinous processes, most commonly through partial removal of bone (osteotomy or resection) or, less frequently, the insertion of an interspinous spacer device.

Understanding Kissing Spine (Baastrup's Disease)

Baastrup's disease, or "kissing spine," is a degenerative condition characterized by the abnormal proximity and contact of adjacent spinous processes in the lumbar spine. These bony projections extend backward from the vertebrae, and normally, there is sufficient space between them. When they repeatedly touch, it can lead to:

• Friction and Impingement: Direct contact causes friction and irritation.
• Edema and Inflammation: Swelling and inflammation of the soft tissues (like the interspinous ligament) between the processes.
• Bursitis: Formation of a bursa (fluid-filled sac) between the processes, which can become inflamed.
• Degenerative Changes: Over time, osteophytes (bone spurs) can form, and the bone surfaces may undergo sclerosis (hardening).

Common Symptoms:

• Localized back pain, often worse with extension (arching the back) and relieved by flexion (bending forward).
• Tenderness to palpation over the affected spinous processes.
• Pain that may radiate to the buttocks or thighs, though true radiculopathy (nerve root compression) is uncommon.
• Discomfort with prolonged standing or walking.

The condition is often diagnosed through physical examination and imaging studies such as X-rays (showing close approximation and degenerative changes), CT scans, or MRI, which can reveal inflammation and soft tissue involvement.

When Is Surgery Considered for Kissing Spine?

Surgical intervention for Baastrup's disease is typically considered a last resort, pursued only after a comprehensive course of conservative, non-surgical treatments has failed to provide adequate symptom relief. Conservative management strategies usually include:

• Rest and activity modification: Avoiding movements that exacerbate pain.
• Physical therapy: Strengthening core muscles, improving posture, and increasing spinal mobility.
• Non-steroidal anti-inflammatory drugs (NSAIDs): To reduce pain and inflammation.
• Corticosteroid injections: Targeted injections into the affected interspinous space or bursa to reduce localized inflammation.
• Manual therapy: Techniques to improve spinal mechanics.

Criteria for Surgical Consideration:

• Persistent, debilitating pain despite at least 3-6 months of consistent conservative treatment.
• Significant functional impairment due to pain.
• Clear anatomical correlation between the spinous process impingement and the patient's symptoms on imaging.

Surgical Approaches for Kissing Spine

The primary goal of surgery for kissing spine is to decompress the impinged area by creating more space between the affected spinous processes. The specific surgical technique chosen depends on the severity of the condition, the number of levels involved, and the surgeon's preference.

1. Spinous Process Osteotomy or Partial Resection

This is one of the most common and direct surgical approaches.

• Procedure: The surgeon makes an incision over the affected area of the spine. A portion of one or both of the impinging spinous processes is carefully removed (osteotomy means cutting bone, resection means removal). The aim is to remove just enough bone to eliminate the contact and friction without destabilizing the spine.
• Mechanism: By resecting the tip or a portion of the spinous process, the physical impingement is removed, reducing pain and inflammation.
• Variations: This can be performed as an open procedure or, increasingly, using minimally invasive techniques, which involve smaller incisions and less muscle disruption, potentially leading to faster recovery.

2. Interspinous Process Decompression/Spacer Insertion

This approach involves implanting a device between the spinous processes to maintain separation.

• Procedure: A small incision is made, and a specialized implant (spacer) is inserted into the interspinous space. These devices are typically made of biocompatible materials like titanium or PEEK (polyether ether ketone).
• Mechanism: The spacer acts as a "prop" to keep the spinous processes apart, preventing direct contact and relieving pressure on neural structures or inflamed soft tissues. These devices are designed to limit extension and maintain flexion, which can be beneficial for patients whose pain is worse with extension.
• Considerations: While less invasive than full laminectomy or fusion, the long-term efficacy and potential for device-related complications (e.g., migration, fracture, persistent pain) are ongoing areas of research. These are often used for conditions like lumbar spinal stenosis that also involve Baastrup's, but can be used primarily for Baastrup's in selected cases.

3. Ligamentum Flavum Resection (Less Common as Primary Surgery for Baastrup's)

While not a primary treatment for Baastrup's disease itself, if the thickened ligamentum flavum (a ligament connecting the laminae of adjacent vertebrae) is contributing to spinal canal stenosis alongside the kissing spine, a partial resection of this ligament may be performed concurrently to decompress neural elements.

What to Expect: Pre-operative, During, and Post-operative

Understanding the journey helps in preparing for surgery.

Pre-operative Assessment

• Thorough medical evaluation, including blood tests, imaging reviews, and possibly a physical therapy assessment to establish a baseline.
• Discussion of surgical risks, benefits, and alternatives.
• Optimization of general health status to ensure the best surgical outcome.

The Procedure Itself

• Performed under general anesthesia.
• Duration varies depending on the specific technique and number of levels involved, typically 1-2 hours.
• Patients usually stay in the hospital for 1-2 days following the procedure.

Post-operative Recovery and Rehabilitation

• Immediate Post-op: Pain management, early mobilization (walking), and wound care.
• Rehabilitation: Physical therapy is crucial for optimal recovery. It typically begins shortly after surgery and focuses on:
  • Pain control and swelling reduction.
  • Gradual restoration of mobility and flexibility.
  • Strengthening of core and back muscles to support the spine and prevent recurrence.
  • Education on proper body mechanics for daily activities.
• Return to Activity: Varies widely, but light activities can often resume within a few weeks, with a full return to more strenuous activities taking several months, guided by the surgeon and physical therapist.

Potential Risks and Complications

As with any surgical procedure, there are potential risks, though serious complications are rare:

• Infection at the surgical site.
• Bleeding.
• Nerve damage (though rare for this type of surgery).
• Persistent pain or incomplete relief of symptoms.
• Recurrence of impingement.
• Anesthesia-related complications.
• Hardware complications (if a spacer is used), such as migration or failure.

Long-Term Outlook and Management

The long-term outlook following surgery for Baastrup's disease is generally positive for patients who meet the criteria for surgical intervention and undergo successful procedures. Many experience significant pain relief and improved functional capacity.

However, it's important to remember that Baastrup's disease is often a degenerative condition. Even after surgery, ongoing management is critical:

• Adherence to a regular exercise program: Focused on core strength, flexibility, and maintaining good posture.
• Weight management: Reducing excess load on the spine.
• Ergonomic adjustments: In daily life and work settings.
• Regular follow-ups: With a healthcare provider to monitor spinal health.

Surgery for kissing spine is a viable option for select individuals whose debilitating pain has not responded to conservative treatments. A thorough evaluation by a spine specialist is essential to determine the most appropriate course of action.