Primary pain generator identification by CT-SPECT in patients with degenerative spinal disease

Tender, Gabriel C.; Davidson, Caroline; Shields, Jessica; Robichaux, Jared; Park, Joe; Crutcher, Clifford; DiGiorgio, Anthony M

doi:10.3171/2019.9.focus19608

Cited by 19 publications

(9 citation statements)

References 19 publications

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“…Increasing evidence exists on the relationship between pain-causing DDD or facet arthropathy and SPECT positivity [ 6 , 24 ]. These findings have been recently confirmed by surgical studies [ 3 , 21 ]. However, the evidence for the effect of surgical treatment of SPECT-positive lumbar degeneration is not conclusive because of the small number of operated cases, combining different surgical techniques and single- and multi-level fusions in different areas of the spine [ 25 ].…”

Section: Introductionsupporting

confidence: 65%

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Spinal fusion for single-level SPECT/CT positive lumbar degenerative disc disease: the SPINUS I study

et al. 2023

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Introduction and purpose With current imaging modalities and diagnostic tests, identifying pain generators in patients with non-specific chronic low back pain (CLBP) is difficult. There is growing evidence of the effectiveness of SPECT/CT examination in diagnosing the source of pain in the spine. The study aims to investigate the effect of posterior interbody fusion on a single-level SPECT/CT positive lumbar degenerative disc disease (DDD). Material and methods This is a prospective study of patients with chronic low back pain (CLBP) operated on for a single-level SPECT/CT positive DDD. Primary outcomes were changes in visual analogue scale (VAS) scores and the Oswestry Disability Index (ODI). Secondary outcomes were complications, return to work, satisfaction and willingness to re-undergo surgery. Results During a 3-year period, 38 patients underwent single-level fusion surgery. The mean preoperative VAS score of 8.4 (± 1.1) decreased to 3.2 (± 2.5, p < 0.001) and the mean preoperative ODI of 51.5 (± 7.3) improved to 20.7 (± 14.68, p < 0.001) at a 2-year follow-up. A minimum clinically important difference (30% reduction in VAS and ODI) was achieved in 84.2% of patients. Some 71% of patients were satisfied with the surgery results and 89.4% would undergo surgery again. There were four complications, and two patients underwent revision surgery. Some 82.9% of patients returned to work. Conclusion Fusion for one-level SPECT/CT positive lumbar DDD resulted in substantial clinical improvement and satisfaction with surgical treatment. Therefore, SPECT/CT imaging could be useful in assessing patients with CLBP, especially those with unclear MRI findings. Trial registration ClinicalTrials.gov Identifier: NCT04876586.

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Section: Introductionsupporting

confidence: 65%

“…Tender et al also found significant improvement in their 23 patients undergoing lumbar fusion (only 13 for single-level SPECT + DDD). The VAS score for axial pain decreased from 9.35 (± 0.7) preoperatively to 4.87 (± 2.3) 6 months postoperatively [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Spinal fusion for single-level SPECT/CT positive lumbar degenerative disc disease: the SPINUS I study

et al. 2023

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“…A potential limitation arises from the fact that patient-reported neck pain before surgery was collected through phone calls. However, this is a commonly used method in observational studies on this topic [ 7 , 20 ]. To minimize potential information bias, professionals collecting patient-reported outcome data are trained to do so and are blinded to whether patients were submitted to an SPECT-CT before the procedure.…”

Section: Discussionmentioning

confidence: 99%

Single-Photon Emission Computed Tomography (SPECT-CT) as a Predictor of Pain Generators in Patients Undergoing Anterior Cervical Discectomy and Fusion (ACDF) for Axial Cervical Pain

Garcia,

Akinduro,

De Biase

et al. 2024

Cureus

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Background: Axial neck pain is often associated with cervical instability, and surgical options are often reserved for patients with either neurological compromise or deformity of the spine. However, cervical facet arthropathy is often implicated with instability and the location of painful generators is often difficult to ascertain. Single-photon emission computed tomography (SPECT-CT) presents an adjunct to conventional imaging in the workup of patients with suspected facetogenic pain. We aimed to report our experience with patients undergoing anterior cervical discectomy and fusion (ACDF) guided by SPECT-CT for axial cervical pain. Methods: We retrospectively identified all cases undergoing ACDF that presented with axial neck pain where correlating SPECT-CT high metabolism areas were identified. Patients were treated at a tertiary care institution between January 2018 and January 2021. Patients with positive radiotracer uptake pre-operatively were compared with patients undergoing ACDF without uptake on SPECT-CT. The pre- and post-operative patients who reported neck pain at one year were compared. Results: Thirty-five patients were included in this retrospective cohort. The median pre- and post-intervention (at one-year follow-up) visual analog score (VAS) of patients undergoing ACDF without uptake on SPECT-CT was 7 and 3 (p<0.01), while the pre- and post-VAS for patients undergoing surgery with positive uptake on SPECT-CT was 8.5 and 0 (p<0.01). Improvement was significantly larger for patients undergoing SPECT-CT-guided ACDF (p=0.02). At one year after surgery, none of the assessed patients required additional surgical intervention. Conclusion: This case series represents the experience of our group to date with patients undergoing SPECT-CT-guided ACDF with results suggesting potential benefit in guiding fusion.

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“…22 A retrospective analysis of 48 patients, who underwent SPECT/CT to help identify the pain generator in neck and lower back pain and subsequently had cervical or lumbar fusion, noted a significant improvement in self-reported pain scores at 6 months postsurgery, suggesting that SPECT/CT may have some diagnostic advantages over current imaging modalities in correctly identifying pain generators in axial spine disease. 23 A smaller prospective study of back pain in older adult patients ( n = 5) demonstrated the usefulness of SPECT/CT in correctly identifying the specific cause of pain in patients with lumbar degenerative disease. 24…”

Section: Reviewmentioning

confidence: 99%

Radiotracers in the Diagnosis of Pain: A Mini Review

Hascalovici,

Babb,

Norwood

2023

Semin Musculoskelet Radiol

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The diagnosis and understanding of pain is challenging in clinical practice. Assessing pain relies heavily on self-reporting by patients, rendering it inherently subjective. Traditional clinical imaging methods such as computed tomography and magnetic resonance imaging can only detect anatomical abnormalities, offering limited sensitivity and specificity in identifying pain-causing conditions. Radiotracers play a vital role in molecular imaging that aims to identify abnormal biological processes at the cellular level, even in apparently normal anatomical structures. Therefore, molecular imaging is an important area of research as a prospective diagnostic modality for pain-causing pathophysiology. We present a mini review of the current knowledge base regarding radiotracers for identification of pain in vivo. We also describe radiocaine, a novel positron emission tomography imaging agent for sodium channels that has shown great potential for identifying/labeling pain-producing nerves and producing an objectively measurable pain intensity signal.

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Primary pain generator identification by CT-SPECT in patients with degenerative spinal disease

Cited by 19 publications

References 19 publications

Spinal fusion for single-level SPECT/CT positive lumbar degenerative disc disease: the SPINUS I study

Spinal fusion for single-level SPECT/CT positive lumbar degenerative disc disease: the SPINUS I study

Single-Photon Emission Computed Tomography (SPECT-CT) as a Predictor of Pain Generators in Patients Undergoing Anterior Cervical Discectomy and Fusion (ACDF) for Axial Cervical Pain

Radiotracers in the Diagnosis of Pain: A Mini Review

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