Use of SPECT-CT Alters Management of Low Back Pain

Using SPECT-CT allows clinicians to identify some causes of low back pain.

Management of low back pain is frequently changed when clinicians use SPECT-CT to identify the causes of low back pain, according to a study to be presented in September at the Royal College of Radiologists Annual Scientific Meeting, which will be held in London, U.K.

In this retrospective study, researchers evaluated whether using SPECT-CT would change the management of patients who present with lower back pain. They evaluated 29 SPECT-CT scans, reviewing clinical history and previous surgical and radiological management, before and after the scan.

Number of patients
Pain originated from facet joints
Pain originated from the SI joints
Pain originated from a Bertolotti joint
Showed discogenic pain

Of the patients whose pain originated from joints, none underwent surgery. Of the seven who had discogenic pain, one patient had L5 pars defects and all seven were either advised to have or did have surgery.

Three of the 29 cases were used to rule out infection; six cases showed increased activity in facet joints on the opposite side of symptoms, and five cases showed no increased activity. There were also two patients who were advised to have surgery because of non-union identified on the CT that did not show increased activity

The researchers concluded that SPECT-CT was found to change management in 76 percent of the patients who had lower back pain. They were able to identify discogenic and joint pain, and to rule out infection. However, the imaging was “not useful for identifying the source of pain in non-union, and in half of the cases of facet joint pain; increased activity was seen on the opposite side of symptoms,” they wrote.

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