Prevalence, MRI Characteristics, and Sports-Related Associations of Baastrup's Disease in Pediatric Athletes With Low Back Pain: A STIR-MRI-Based Study
Sports health · 2026
Baastrup's disease turned up on STIR-MRI in over a quarter of young athletes with back pain, but this study can't say it's actually causing the pain.
Part of: Training load and injury risk: what the evidence says · Youth and adolescent athletes: training, injury and development
The paper
Cross-sectional retrospective study, n=177 pediatric athletes (mean age 14.1, range 9-18) presenting with low back pain.
What they found
Baastrup's disease was identified on STIR-MRI in 50 of 177 athletes (28.2%). Affected athletes were older with longer sports participation and more often played basketball or speed skating; absence of lumbar spondylolysis was independently associated with Baastrup's disease (adjusted OR 0.30, 95% CI 0.12-0.75).
Study design
Retrospective cross-sectional cohort, Level of Evidence 3, single-institution imaging review of 177 pediatric athletes with LBP referred for MRI, not a population-based prevalence study.
Methodology
This is a retrospective chart/image review of athletes already referred for MRI because of LBP, so the 28.2% figure reflects prevalence in a selected symptomatic clinical population, not in pediatric athletes generally, and cannot establish that Baastrup's disease caused the pain. STIR-MRI presence was presumably read by the study radiologists with no blinding described, raising detection bias risk, and no inter-rater reliability is reported for the STIR classification. Multivariate logistic regression adjusts for some confounders but with 50 cases the model risks overfitting given the number of candidate predictors, and there is no comparison to asymptomatic controls, so the 0.30 odds ratio for spondylolysis absence describes an association within this back-pain cohort, not a causal or diagnostic pathway. A clinician wanting to verify the STIR finding would need the same MRI protocol and a radiologist trained in this specific sequence interpretation.
The appraisal
The prevalence estimate is descriptive and hypothesis-generating rather than confirmatory. The adjusted OR of 0.30 (95% CI 0.12-0.75) for the inverse spondylolysis-Baastrup's link is a fairly strong association, not a modest one, but the wide confidence interval reflects a small subgroup and limited precision. Either way, an odds ratio from a single cross-sectional dataset says nothing about whether Baastrup's changes are the actual pain generator or an incidental finding that co-occurs with a particular sporting exposure. Without asymptomatic controls or a pain-attribution outcome (STIR signal location versus reported pain site, or response to targeted treatment), this cannot support a causal claim that Baastrup's disease is a distinct clinical entity driving LBP in these athletes.
The gap
No asymptomatic control group and no direct correlation between STIR signal intensity/location and reported pain site or response to treatment, so it's unclear whether Baastrup's disease found on MRI is the actual pain source or just a bystander finding in athletes who happen to have back pain from something else. This is also a retrospective sample of athletes who were already referred for lumbar MRI, a more selected, likely more severe or persistent group than the average young athlete with LBP seen pitch-side or in first-contact clinic, so the 28.2% figure will not generalize to every adolescent with a sore back.
Landmark context
This builds on the classic description of Baastrup's disease (kissing spinous processes) as an adult degenerative phenomenon and on the pediatric spondylolysis literature, since this paper's most notable finding is that spondylolysis and Baastrup's disease appear to be inversely associated in young athletes, a novel pediatric-specific observation rather than a confirmation of prior work.
What to do Monday
For a young athlete with LBP and a negative spondylolysis workup, clinicians ordering STIR-MRI should specifically look for interspinous edema/Baastrup's changes as a differential, but this alone should not change treatment decisions since the pain-causation link is unproven.
In practice
This applies to adolescent athletes, roughly early teens through late teens, with LBP who've already had a negative spondylolysis workup, particularly those in basketball, speed skating or other sports that aren't extension-dominant. In clinic, if STIR-MRI shows interspinous edema, log it as a plausible contributor alongside your usual assessment, don't assume a flexion-biased or extension-light sport rules out spinous process pathology, and manage it like any other non-specific overuse LBP: activity modification, graded reload, reassess against symptoms rather than chasing the scan. On the performance floor, the practical takeaway is that cumulative training duration, not just movement pattern, tracked as a risk marker here, so flag athletes logging long-term high-volume basketball or speed skating training for closer LBP monitoring even though their sport doesn't load extension heavily. The caveat in both settings is the same: this is an MRI finding with an unproven link to symptoms, so a positive scan shouldn't by itself drive time-loss decisions or turn an ordinary overuse presentation into something more medicalized than it needs to be.
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