SPECT/CT Imaging of the Lumbar Spine in Chronic Low Back Pain: a Case Report

Overview

Journal Chiropr Man Therap

Publisher Biomed Central

Date 2011 Jan 21

PMID 21247412

Citations 6

Authors

Michael H Carstensen

Mashael Al-Harbi

Jean-Luc Urbain

Tarik-Zine Belhocine

Affiliations

Soon will be listed here.

Abstract

Mechanical low back pain is a common indication for Nuclear Medicine imaging. Whole-body bone scan is a very sensitive but poorly specific study for the detection of metabolic bone abnormalities. The accurate localisation of metabolically active bone disease is often difficult in 2D imaging but single photon emission computed tomography/computed tomography (SPECT/CT) allows accurate diagnosis and anatomic localisation of osteoblastic and osteolytic lesions in 3D imaging. We present a clinical case of a patient referred for evaluation of chronic lower back pain with no history of trauma, spinal surgery, or cancer. Planar whole-body scan showed heterogeneous tracer uptake in the lumbar spine with intense localisation to the right lateral aspect of L3. Integrated SPECT/CT of the lumbar spine detected active bone metabolism in the right L3/L4 facet joint in the presence of minimal signs of degenerative osteoarthrosis on CT images, while a segment demonstrating more gross degenerative changes was more quiescent with only mild tracer uptake. The usefulness of integrated SPECT/CT for anatomical and functional assessment of back pain opens promising opportunities both for multi-disciplinary clinical assessment and treatment for manual therapists and for research into the effectiveness of manual therapies.

Citing Articles

Coronal Deformity is Associated With Uptake on Single Photon Emission Computed Tomography in Patients With Low Back Pain.

Dharia A, Guillotte A, De Stefano F, Birney M, Rouse A, Ohiorhenuan I Global Spine J. 2024; :21925682241265302.

PMID: 38896877 PMC: 11571455. DOI: 10.1177/21925682241265302.

Primary pain generator identification by CT-SPECT in a patient with low back pain: a case report.

Tender G, Constantinescu A, Conger A, Digiorgio A BMC Res Notes. 2017; 10(1):132.

PMID: 28327190 PMC: 5361848. DOI: 10.1186/s13104-017-2458-3.

Radiological and Radionuclide Imaging of Degenerative Disease of the Facet Joints.

Shur N, Corrigan A, Agrawal K, Desai A, Gnanasegaran G Indian J Nucl Med. 2015; 30(3):191-8.

PMID: 26170560 PMC: 4479906. DOI: 10.4103/0972-3919.158526.

The value of SPECT/CT in localizing pain site and prediction of treatment response in patients with chronic low back pain.

Lee I, Budiawan H, Moon J, Cheon G, Kim Y, Paeng J J Korean Med Sci. 2014; 29(12):1711-6.

PMID: 25469075 PMC: 4248596. DOI: 10.3346/jkms.2014.29.12.1711.

The clinical rehabilitation of spine and spinal cord disorders: detection and evaluation using SPECT/CT.

Scheyerer M, Werner C, Veit-Haibach P Neural Regen Res. 2014; 9(8):795-7.

PMID: 25206891 PMC: 4146248. DOI: 10.4103/1673-5374.131593.

References

Deyo R, Weinstein J . Low back pain. N Engl J Med. 2001; 344(5):363-70. DOI: 10.1056/NEJM200102013440508. View

Kalichman L, Hunter D . Lumbar facet joint osteoarthritis: a review. Semin Arthritis Rheum. 2007; 37(2):69-80. DOI: 10.1016/j.semarthrit.2007.01.007. View

Buck A, Nekolla S, Ziegler S, Beer A, Krause B, Herrmann K . SPECT/CT. J Nucl Med. 2008; 49(8):1305-19. DOI: 10.2967/jnumed.107.050195. View

Even-Sapir E, Flusser G, Lerman H, Lievshitz G, Metser U . SPECT/multislice low-dose CT: a clinically relevant constituent in the imaging algorithm of nononcologic patients referred for bone scintigraphy. J Nucl Med. 2007; 48(2):319-24. View

Schillaci O . Hybrid SPECT/CT: a new era for SPECT imaging?. Eur J Nucl Med Mol Imaging. 2005; 32(5):521-4. DOI: 10.1007/s00259-005-1760-9. View

Kalichman L, Li L, Kim D, Guermazi A, Berkin V, ODonnell C . Facet joint osteoarthritis and low back pain in the community-based population. Spine (Phila Pa 1976). 2008; 33(23):2560-5. PMC: 3021980. DOI: 10.1097/BRS.0b013e318184ef95. View

Haldeman S . Low back pain: current physiologic concepts. Neurol Clin. 1998; 17(1):1-15. DOI: 10.1016/s0733-8619(05)70111-0. View

Gnanasegaran G, Barwick T, Adamson K, Mohan H, Sharp D, Fogelman I . Multislice SPECT/CT in benign and malignant bone disease: when the ordinary turns into the extraordinary. Semin Nucl Med. 2009; 39(6):431-42. DOI: 10.1053/j.semnuclmed.2009.07.005. View

Papathanassiou D, Bruna-Muraille C, Jouannaud C, Gagneux-Lemoussu L, Eschard J, Liehn J . Single-photon emission computed tomography combined with computed tomography (SPECT/CT) in bone diseases. Joint Bone Spine. 2009; 76(5):474-80. DOI: 10.1016/j.jbspin.2009.01.016. View

10.

Ryan P, Evans P, Gibson T, Fogelman I . Chronic low back pain: comparison of bone SPECT with radiography and CT. Radiology. 1992; 182(3):849-54. DOI: 10.1148/radiology.182.3.1531544. View

11.

Bombardieri E, Aktolun C, Baum R, Bishof-Delaloye A, Buscombe J, Chatal J . Breast scintigraphy: procedure guidelines for tumour imaging. Eur J Nucl Med Mol Imaging. 2004; 30(12):BP107-14. DOI: 10.1007/s00259-003-1354-3. View

12.

Kanmaz B, Collier B, Liu Y, Uzum F, Uygur G, Akansel G . SPET and three-phase planar bone scintigraphy in adult patients with chronic low back pain. Nucl Med Commun. 1998; 19(1):13-21. DOI: 10.1097/00006231-199801000-00004. View

13.

McDonald M, Cooper R, Wang M . Use of computed tomography-single-photon emission computed tomography fusion for diagnosing painful facet arthropathy. Technical note. Neurosurg Focus. 2007; 22(1):E2. DOI: 10.3171/foc.2007.22.1.2. View