Baastrup’s disease is characterized by close approximation and abutment of spinous processes, interspinal bursitis, interspinous ligament degeneration/tears, subcortical cysts/erosions, edema, chondroid metaplasia, enchondral ossification involving opposing spinous processes, creation of synovial articulations, and occasionally the development of epidural cysts or epidural fibrotic masses
Interspinous bursitis can communicate with Baastrup’s associated epidural cysts, the facet joints(leads to a classic butterfly appearance), as well as pars interarticularis defects.
Fluid within the retrodural space of Okada dorsal to the ligamentum flavum (blue arrow), extending into the bilateral facet joints and posteriorly into an interspinous bursa.
The fluid creates a “Y”- or wishbone-shaped configuration.
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References
1. Jang EC, Song KS, Lee HJ, Kim JY, Yang JJ. Posterior epidural fibrotic mass associated with Baastrup's disease.
Eur Spine J. 2010 Jul;19 Suppl 2(Suppl 2):S165-8.
doi: 10.1007/ s00586-009-1262-8. Epub 2010 Jan 9. PMID: 20063020; PMCID: PMC2899643.
2. Chen CK, Yeh L, Resnick D, Lai PH, Liang HL, Pan HB, Yang CF. Intraspinal posterior epidural cysts associated with Baastrup's disease: report of 10 patients.
AJR Am J Roentgenol. 2004 Jan;182(1):191-4. doi: 10.2214/ajr.182.1.1820191. PMID: 14684538.
3. Lehman VT, Murthy NS, Diehn FE, Verdoorn JT, Maus TP. The posterior ligamentous complex inflammatory syndrome: spread of fluid and inflammation in the retrodural space of Okada.
Clin Radiol. 2015 May;70(5):528-35.
doi: 10.1016/j.crad.2014.12.009. Epub 2015 Jan 7. PMID: 25577652.
4. MRI Web Clinic — December 2017 Baastrup’s Disease John F. Carroll, M.D.
https://radsource.us/baastrups_disease/
