J Korean Med Sci.  2014 Dec;29(12):1711-1716. 10.3346/jkms.2014.29.12.1711.

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 JY
• Cheon GJ
• Kim YC
• Paeng JC
• Kang KW
• Chung JK
• Lee DS

• KMID: 2069964
• DOI: http://doi.org/10.3346/jkms.2014.29.12.1711

Abstract

In many circumstances, causing sites of low back pain (LBP) cannot be determined only by anatomical imaging. Combined functional and morphological imaging such as bone scan with single-photon emission computed tomography/computed tomography (SPECT/CT) may be helpful in identifying active lesions. The purpose of this study was to evaluate the usefulness of bone SPECT/CT in localizing the pain site and the treatment of chronic LBP. One hundred seventy-five patients suffering from chronic LBP who underwent SPECT/CT were included, retrospectively. All of the patients received multiple general treatments according to the symptoms, and some of them underwent additional target-specific treatment based on SPECT/CT. Numerical rating scale (NRS) pain score was used to assess the pain intensity. Of 175 patients, 127 showed good response to the given therapies, while the rest did not. Overall, 79.4% of patients with definite active lesions showed good response. Patients with mild active or no lesions on SPECT/CT had relatively lower response rate of 63.0%. Good response was observed by the treatment with the guidance of active lesions identified on SPECT/CT. SPECT/CT could be useful in identifying active lesions in patients with chronic LBP and guiding the clinicians to use adequate treatment.

Keyword

Low Back Pain; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed; Pain Management; Technetium-99m (Tc-99m), Methylene Diphosphonate (MDP)

MeSH Terms

Adolescent
Adult
Aged
Aged, 80 and over
Chronic Pain/*diagnosis/*therapy
Female
Humans
Low Back Pain/*diagnosis/*therapy
Lumbar Vertebrae/radiography/radionuclide imaging
Male
Middle Aged
Multimodal Imaging/methods
Pain Measurement/*methods
Reproducibility of Results
Retrospective Studies
Sensitivity and Specificity
Tomography, Emission-Computed, Single-Photon/*methods
Tomography, X-Ray Computed/*methods
Treatment Outcome
Young Adult

Figure

• 

  Fig. 1 Treatment response according to the intensity of lesions in SPECT/CT. The patients with definite uptake in SPECT/CT have better treatment response compared to the patients with no or mild uptake in SPECT/CT. *P = 0.017 (Pearson chi square).

Reference

1. Hoy D, Brooks P, Blyth F, Buchbinder R. The Epidemiology of low back pain. Best Pract Res Clin Rheumatol. 2010; 24:769–781.

2. Frymoyer JW. Back pain and sciatica. N Engl J Med. 1988; 318:291–300.

3. Powell MC, Wilson M, Szypryt P, Symonds EM, Worthington BS. Prevalence of lumbar disc degeneration observed by magnetic resonance in symptomless women. Lancet. 1986; 2:1366–1367.

4. Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med. 1994; 331:69–73.

5. Jarvik JJ, Hollingworth W, Heagerty P, Haynor DR, Deyo RA. The Longitudinal Assessment of Imaging and Disability of the Back (LAIDBack) Study: baseline data. Spine (Phila Pa 1976). 2001; 26:1158–1166.

6. Bogduk N, McGuirk B. Medical management of acute chronic low back pain : an evidence-based approach. Amsterdam; Boston: Elsevier;2002. p. 173–174.

7. Last AR, Hulbert K. Chronic low back pain: evaluation and management. Am Fam Physician. 2009; 79:1067–1074.

8. Ryan PJ, Evans PA, Gibson T, Fogelman I. Chronic low back pain: comparison of bone SPECT with radiography and CT. Radiology. 1992; 182:849–854.

9. 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; 48:319–324.

10. Kretzschmar M, Wiewiorski M, Rasch H, Jacob AL, Bilecen D, Walter MA, Valderrabano V. 99mTc-DPD-SPECT/CT predicts the outcome of imaging-guided diagnostic anaesthetic injections: a prospective cohort study. Eur J Radiol. 2011; 80:e410–e415.

11. Carstensen MH, Al-Harbi M, Urbain JL, Belhocine TZ. SPECT/CT imaging of the lumbar spine in chronic low back pain: a case report. Chiropr Man Therap. 2011; 19:2.

12. Dworkin RH, Turk DC, Farrar JT, Haythornthwaite JA, Jensen MP, Katz NP, Kerns RD, Stucki G, Allen RR, Bellamy N, et al. Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain. 2005; 113:9–19.

13. Turk DC, Melzack R. Handbook of pain assessment. 3rd ed. New York: Guilford Press;2011. p. 19–44.

14. Manejias EM, Hu J, Tatli Y, Lutz GE. Lumbar zygapophysial joint radiofrequency denervation: a long-term clinical outcome study. HSS J. 2008; 4:180–187.

15. Sloman R, Wruble AW, Rosen G, Rom M. Determination of clinically meaningful levels of pain reduction in patients experiencing acute postoperative pain. Pain Manag Nurs. 2006; 7:153–158.

16. Koh WU, Kim SH, Hwang BY, Choi WJ, Song JG, Suh JH, Leem JG, Shin JW. Value of Bone Scintigraphy and Single Photon Emission Computed Tomography (SPECT) in Lumbar Facet Disease and Prediction of Short-term Outcome of Ultrasound Guided Medial Branch Block with Bone SPECT. Korean J Pain. 2011; 24:81–86.

17. Holder LE, Machin JL, Asdourian PL, Links JM, Sexton CC. Planar and high-resolution SPECT bone imaging in the diagnosis of facet syndrome. J Nucl Med. 1995; 36:37–44.

18. Dolan AL, Ryan PJ, Arden NK, Stratton R, Wedley JR, Hamann W, Fogelman I, Gibson T. The value of SPECT scans in identifying back pain likely to benefit from facet joint injection. Br J Rheumatol. 1996; 35:1269–1273.

19. McDonald M, Cooper R, Wang MY. Use of computed tomography-single-photon emission computed tomography fusion for diagnosing painful facet arthropathy. Technical note. Neurosurg Focus. 2007; 22:E2.

20. Tuite MJ. Facet joint and sacroiliac joint injection. Semin Roentgenol. 2004; 39:37–51.

21. Grob KR, Neuhuber WL, Kissling RO. [Innervation of the sacroiliac joint of the human]. Z Rheumatol. 1995; 54:117–122.

22. Fortin JD, Kissling RO, O'Connor BL, Vilensky JA. Sacroiliac joint innervation and pain. Am J Orthop (Belle Mead NJ). 1999; 28:687–690.

23. Frymoyer JW, Ducker TB. The Adult spine : principles and practice. New York: Raven Press;1991. p. 143–150.

24. Vilensky JA, O'Connor BL, Fortin JD, Merkel GJ, Jimenez AM, Scofield BA, Kleiner JB. Histologic analysis of neural elements in the human sacroiliac joint. Spine (Phila Pa 1976). 2002; 27:1202–1207.

25. Murata Y, Takahashi K, Yamagata M, Takahashi Y, Shimada Y, Moriya H. Origin and pathway of sensory nerve fibers to the ventral and dorsal sides of the sacroiliac joint in rats. J Orthop Res. 2001; 19:379–383.

26. Slipman CW, Sterenfeld EB, Chou LH, Herzog R, Vresilovic E. The value of radionuclide imaging in the diagnosis of sacroiliac joint syndrome. Spine (Phila Pa 1976). 1996; 21:2251–2254.

27. Appel H, Maier R, Loddenkemper C, Kayser R, Meier O, Hempfing A, Sieper J. Immunohistochemical analysis of osteoblasts in zygapophyseal joints of patients with ankylosing spondylitis reveal repair mechanisms similar to osteoarthritis. J Rheumatol. 2010; 37:823–828.

28. Ratcliffe A, Seibel MJ. Biochemical markers of osteoarthritis. Curr Opin Rheumatol. 1990; 2:770–776.

29. Woo JH, Lee HJ, Sung IH, Kim TH. Changes of clinical response and bone biochemical markers in patients with ankylosing spondylitis taking etanercept. J Rheumatol. 2007; 34:1753–1759.

30. Chun IK, Cheon GJ, Paeng JC, Kang KW, Chung JK, Lee DS. Detection and Characterization of Parathyroid Adenoma/Hyperplasia for Preoperative Localization: Comparison Between (11)C-Methionine PET/CT and (99m)Tc-Sestamibi Scintigraphy. Nucl Med Mol Imaging. 2013; 47:166–172.

31. Hong CM, Ahn BC, Choi SY, Kim DH, Lee SW, Kwon TG, Lee J. Implications of three-phase bone scintigraphy for the diagnosis of bisphosphonate-related osteonecrosis of the jaw. Nucl Med Mol Imaging. 2012; 46:162–168.