Baastrup's disease in a patient with multifactorial back pain: a case report

Lower back pain is a common yet often misdiagnosed condition due to its multifactorial nature and presence of other underlying pathologies. Baastrup's disease is an underdiagnosed cause of lower back pain. We present a case of a 67-year-old female who initially presented with lower back pain and associated radiation to bilateral lower extremities. The patient's imaging revealed moderate spinal canal stenosis at L4-L5 due to grade 1 anterolisthesis, severe right L5-S1 neural foraminal stenosis, and a dorsal epidural cyst with interspinous bursitis possibly related to Baastrup's disease. The patient underwent L4-L5 interlaminar epidural steroid injection with cyst aspiration under fluoroscopic guidance and had temporary relief. Given the multifactorial nature of her pain, she subsequently underwent greater trochanter bursa steroid injections and bilateral L3-L5 medial branch blocks, resulting in significant pain relief. Our case demonstrates the multifactorial nature of lower back pain, where treatment of each underlying aspect, including identification of Baastrup's Disease with associated epidural cyst, resulted in pain relief. It also underscored the importance of considering the patient's history when using steroid injections in interventional procedures and determining when a patient is more appropriate for surgery.