baastrups

[myrandom2003]

you guys been diagnosing this a lot? I see it all the time now that I look for it, but I don't necessarily officially diagnose it. PT helps. not sure what to code a interspinous block other than a trigger point. role for vertiflex?

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[knoxdoc]

I have it, it sucks. PT for flexion-based DLS and interspinous bursa injections (coded as small bursa injection if you want) will help most patients. Use a knee wedge at night to keep some lumbar flexion while sleeping. I had my friend RF the bursa and it has helped by about 50-60% for 6 months thus far. An RF case at Mayo was reported in 2018 by Clark and Lamer (attached). Some have tried X-stop and others have tried posterior decompression with limited success. I welcome any other ideas. I have no clue about Vertiflex specifically, but I recently had a NS complain about trying to get an x-stop out and having to chisel away bone for hours. That makes me very hesitant.

 

[ctts]

Thanks to this post above! Just happened to see a Baastrup situation 4 day ago in a 55 yo. L3-4. Preserved interspinous space, not bone-on-bone situation, with very clear area of high intensity signal on STIR sagittal. I used a 22G Quincke, and when I entered the area, a little bit of clear serous fluid even came up into the hub, although aspiration was negative for any additional fluid. Injected steroid and anesthetic. As she was checking out, she said she felt a little better, but was not a slam dunk, so I was a little uncertain how she would do, but I just heard that she is doing great, back to work, and was able to stop the short-term oxycodone I gave her for acute pain. Ashamed to say that I have not done this before, so I must have missed this many times. I will be looking for this more.

 

[Taus]

Thanks to this post above! Just happened to see a Baastrup situation 4 day ago in a 55 yo. L3-4. Preserved interspinous space, not bone-on-bone situation, with very clear area of high intensity signal on STIR sagittal. I used a 22G Quincke, and when I entered the area, a little bit of clear serous fluid even came up into the hub, although aspiration was negative for any additional fluid. Injected steroid and anesthetic. As she was checking out, she said she felt a little better, but was not a slam dunk, so I was a little uncertain how she would do, but I just heard that she is doing great, back to work, and was able to stop the short-term oxycodone I gave her for acute pain. Ashamed to say that I have not done this before, so I must have missed this many times. I will be looking for this more.

Often related to Posterior ligamentous inflammatory syndrome…. Communication with space of okada

 

[SSdoc33]

HUGE problem in our equine population

but it actually is pretty difficult to treat. interspinous injections probably the best way to go. ? PRP?

 

[Orin]

This should be managed by the ISS if they can be deployed, but I might try something like this:

Successful Relief of Back Pain From Baastrup Disease (Kissing Spines) by Interspinous Radiofrequency Lesioning: A Case Report - PubMed

Baastrup disease is a condition where spinous processes form painful pseudoarticulations. We present a patient with midline axial back pain consistent with Baastrup disease confirmed by computed tomography, which revealed degenerative changes along the opposing surfaces of the spinous processes...

pubmed.ncbi.nlm.nih.gov

 

[Multimodal]

I usually bill 20550 + 76942 as I do all of them under ultrasound guidance. I too feel like I just discovered interspinous ligament problems recently and have had a pretty good response to these injections so far. usually 10mg dex and 3-4cc marcaine is my go to mix.

 

[DODOCSS]

I usually bill 20550 + 76942 as I do all of them under ultrasound guidance. I too feel like I just discovered interspinous ligament problems recently and have had a pretty good response to these injections so far. usually 10mg dex and 3-4cc marcaine is my go to mix.

Adjacent levels = 20551 (x2)