# Surgical Management for a Case of Baastrup's Disease With Concomitant Multiple Lumbar Spondylolysis and Epidural Cyst

## TL;DR

A 56-year-old man with Baastrup's disease and multiple spinal issues underwent successful surgery that relieved his symptoms and restored mobility.

## Contribution

This case report presents a rare combination of Baastrup's disease, multiple lumbar spondylolysis, and epidural cyst managed with a limited fusion and combined fixation approach.

## Key findings

- The patient experienced complete symptom resolution and full mobility after surgery.
- Imaging at two years showed successful L4-L5 fusion with preserved L5-S1 motion.
- Histopathology confirmed the presence of a synovial cyst.

## Abstract

Baastrup's disease is a degenerative condition characterized by the close approximation of adjacent spinous processes. Interspinous bursal cysts may extend into the epidural space, resulting in symptomatic central canal stenosis. Lumbar multiple spondylolysis, characterized by defects in more than one lumbar lamina, is a rare condition often associated with trauma or repetitive stress. This case report presents a 56-year-old male plumber who presented with low back pain and bilateral leg numbness. He had intermittent claudication at 500 m. Imaging revealed L4 spondylolytic spondylolisthesis, L5 spondylolysis, and Baastrup's disease at L3-L4 with an extradural cyst. He underwent L4-L5 posterior lumbar interbody fusion with cyst resection and direct repair of the L5 pars defect using a lamina hook system. Histopathology confirmed a synovial cyst. Symptoms resolved postoperatively, and he regained full mobility. At two years, imaging showed solid L4-L5 fusion with preserved L5-S1 motion. This case highlights the importance of limited fusion to avoid excessive segmental immobilization, with a combined fixation approach providing symptom relief and spinal stability.