Baastrup\'s disease represents a frequent, primarily radiological phenomenon on imaging studies of the spine. Nevertheless, it can present as a rare, symptomatically relevant pathology that implies a therapeutic consequence. Yet, there is little evidence and agreement on a consistent treatment strategy in the current literature. Here, we present the case of a 46-year-old man who presented with chronic, persistent midline back pain that was relieved by flexion and aggravated by spinal extension. Extensive imaging studies, including computed tomography, magnetic resonance imaging, and single-photon emission computed tomography confirmed the close approximation of the spinous processes at the levels L4-L5 and L5-S1. Clinically symptomatic isolated Baastrup\'s disease was confirmed by a local anesthetic infiltration test. As conservative treatment options failed, partial resection of the spinous processes was performed. Conservative treatment, including analgesics and physical therapy, represents the initial treatment approach for Baastrup\'s disease. When clinical features of Baastrup\'s disease are present, differential diagnoses have been excluded, and conventional therapy has been exhausted surgical decompression with low surgical risk and good prognosis may be indicated after careful consideration of the indications.

BACKGROUND: Baastrup\'s Syndrome is a condition that occurs when there is abnormal contact between two adjacent spinous processes resulting in back pain. An alteration in lumbar spinal alignment and/or adjacent segment compensatory motion is thought to be potential causative factors. The objective of this study was to present a case series of what appears to be iatrogenic Baastrup\'s Syndrome as a mid-to-late term complication following anterior lumbar interbody surgery.
METHODS: A retrospective chart review was performed of all patients undergoing anterior lumbar surgery for either fusion or disc replacement to determine the prevalence of Baastrup\'s Syndrome.
RESULTS: Over a 12-year period, 855 patients who had undergone an anterior approach for lumbar spine surgery were identified. Of them 8 patients with evidence of Baastrup\'s Syndrome were found; this demonstrated a prevalence of 0.9%. Diagnostic injection was a helpful clinical tool in confirming the diagnosis of iatrogenic Baastrup\'s Syndrome. The partial removal of the impinging spinous processes resulted in excellent clinical relief.
CONCLUSIONS: Iatrogenic Baastrup\'s Syndrome may be an iatrogenic result of anterior lumbar surgery in small group of patients. Spinous process excision is a suggested treatment option. Further studies are necessary to explore the above phenomenon. This study is a Level 3 retrospective case series.