Introduction. Baastrup's syndrome a.k.a. kissing spine disease was originally described by Dr. Baastrup in the 1930s. This condition, where adjacent spinous processes form a painful pseudoarticulation is not commonly considered in the differential diagnosis and work-up of back pain. In the 3 cases presented, MR imaging and fluoroscopically-guided local injections were helpful in the diagnosis and/or treatment. Methods. Three cases are presented. Each patient had a history of low back pain that did not respond to traditional treatments. MR imaging and the results of local injections are presented. Results. Three patients, each over the age of 65, presented with midline non-radicular back pain unresponsive to oral analgesics, physical therapy, and epidural or facet joint injections. In each patient, the pain was primarily midline, exacerbated by spine extension and reproducible by palpation over the spinous processes. In each case, plain x-rays revealed extensive degenerative changes and notably, adjacent spinous processes that appeared to be in direct contact. MRI findings were impressive and consisted of one or more of the following changes: 1. Edema/inflammation in and surrounding the spinous processes (regions of non-enhancing increased fat-suppressed T2 signal intensity (edema) and enhancement on post-contrast fat suppressed T1 sequences (inflammation). 2. Degenerative geode formation in the spinous process(es). In each patient, fluoroscopically-guided local anesthetic/corticosteroid injection provided pain relief. In two of the patients, the relief was long lasting. In one patient, temporary relief was diagnostic and led to successful surgical resection of the degenerative spinous process. Discussion. This report describes clinical and radiographic features of kissing spine disease. This condition should be considered in patients with midline low back pain when associated with MRI findings of inflammatory and/or edematous changes of the spinous processes and the adjacent soft tissues. Local injection may be diagnostic and/or therapeutic.