178 Adjunctive Use of Preoperative SPECT Imaging for Evaluation of Chronic Cervical and Lumbar Pain

INTRODUCTION: Radionuclide bone scintigraphy with single photon emission computed tomography (SPECT) has been used to evaluate foci of inflammation within the spinal axis. Studies have reported its use as an tool for recognition of pain foci and spondolytic change. As an adjunctive test SPECT may prove to give valuable insight into areas of focal inflammation within the spinal axis and therefore serve as a tool for guiding operative and nonoperative intervention in patients with degenerative spine disease. METHODS: We performed a retrospective case series to identify patients with chronic neck/back pain who underwent SPECT imaging for pre-operative evaluation. Patient demographics, area of uptake, correlation with pain morphology, type of intervention, and degree of symptom resolution were quantified. Patients were excluded if they had prior surgery/intervention at the level corresponding to symptomatology. RESULTS: Thirty-two patients underwent SPECT imaging. Patients presented with axial back pain (97%) and radicular pain (42%). Radiotracer uptake was seen in facet and/or disc space at the level of symptomology in 44% of patients, facet alone (22%), disc space alone (22%), and uncovertebral joint (12%). Interventions included facet injections (26 patients), basovertebral plexus ablation (7 patients), and open/minimally-invasive surgery (9 patients). Two patients underwent anterior cervical discectomy and the remainder of our cohort underwent lumbar instrumentation and fusion. All but one surgical patient (97%) reported significant relief of symptoms. CONCLUSIONS: SPECT imaging may be useful adjunctive imaging modality to evaluate for focal areas of inflammation not readily observed on MRI or CT. Our experience suggests that SPECT can identify areas of pathology that responsive to various types of intervention.