SPECT/CT in patients with lower back pain after lumbar fusion surgery

Schmidt, Daniela; Richter, R.H.; Janka, Rolf; Ritt, Philipp; Uder, Michael; Forst, Raimund; Kuwert, Torsten

doi:10.1097/mnm.0b013e328363cf81

Cited by 30 publications

(12 citation statements)

References 40 publications

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“…Sumer et al assessed the added value of SPECT/CT compared to planar/SPECT imaging in evaluating pain symptoms in a series of 37 patients following lumbar fusion [10]. SPECT/ CT resulted in a reclassification of 45.2 % of described lesions.…”

Section: Discussionmentioning

confidence: 99%

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Accuracy of bone SPECT/CT for identifying hardware loosening in patients who underwent lumbar fusion with pedicle screws

Hudyana

Maes

Vandenberghe

et al. 2015

Eur J Nucl Med Mol Imaging

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Background The aim of this retrospective study was to evaluate the accuracy of bone SPECT (single photon emission computed tomography)/CT (computed tomography) in diagnosing loosening of fixation material in patients with recurrent or persistent back pain that underwent lumbar arthrodesis with pedicle screws using surgery and clinical follow-up as gold standard Methods A total of 48 patients (median age 49 years, range 21-81 years; 17 men) who had undergone lumbar spinal arthrodesis were included in this retrospective analysis. SPECT/ CT results were compared to the gold standard of surgical evaluation or clinical follow-up. Positive SPECT/CT results were considered true positives if findings were confirmed by surgery or if clinical and other examinations were completely consistent with the positive SPECT/CT finding. They were considered false positives if surgical evaluation did not find any loose pedicle screws or if symptoms subsided with non-surgical therapy. Negative SPECT/CT scans were considered true negatives if symptoms either improved without surgical intervention or remained stable over a minimum follow-up period of 6 months. Negative SPECT/CT scans were determined to be false negatives if surgery was still required and loosening of material was found.Results The median length of time from primary surgery to bone SPECT/CT referral was 29.5 months (range 12-192 months). Median follow-up was 18 months (range 6-57) for subjects who did not undergo surgery. Thirteen of the 48 patients were found to be positive for loosening on bone SPECT/CT. Surgical evaluation (8 patients) and clinical follow-up (5 patients) showed that bone SPECT/CT correctly predicted loosening in 9 of 13 patients, while it falsely diagnosed loosening in 4 patients. Of 35 negative bone SPECT/CT scans, 12 were surgically confirmed. In 18 patients, bone SPECT/CT revealed lesions that could provide an alternative explanation for the symptoms of pain (active facet degeneration in 14 patients, and disc and sacroiliac osteodegeneration in 7 patients and 1 patient, respectively). Overall sensitivity and specificity for the detection of loosening were 100 % and 89.7 %, respectively. The positive and negative predictive values were 69 % and 100 %, respectively. Conclusions This retrospective analysis suggests that bone SPECT/CT bone is a highly sensitive and specific tool for the exclusion of screw loosening in patients who present with recurrent low back pain after having undergone lumbar arthrodesis. In addition, it can identify other potential causes of recurrent low back pain in this patient population.

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Section: Discussionmentioning

confidence: 99%

“…In addition, the advent of hybrid imaging, with the combination of SPECT and CT, has significantly improved the anatomical localisation of abnormalities found on SPECT imaging, dramatically improving its specificity [10].…”

Section: Introductionmentioning

confidence: 99%

Accuracy of bone SPECT/CT for identifying hardware loosening in patients who underwent lumbar fusion with pedicle screws

Hudyana

Maes

Vandenberghe

et al. 2015

Eur J Nucl Med Mol Imaging

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“…Depending on the material, orthopedic implants can affect the image quality of MRI scans [66,67]. Bone SPECT/CT has been reported to detect instability of the spondylodesis [68], leading to a change in the diagnostic category in approximately half of patients with lower back pain after LFS [69]. Vertebral osteomyelitis accounts for up to 10 % of all cases of osteomyelitis and commonly affects the elderly.…”

Section: Axial Skeletonmentioning

confidence: 99%

SPECT/CT in infection and inflammation

Erba

Israel²

2014

Clin Transl Imaging

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Nuclear medicine procedures are part of the evaluation armamentarium used in patients with suspected or confirmed infection. The strength of functional imaging modalities rests on their being non-invasive tests that provide pathophysiological information early in the course of disease. Their limitations, related to a somewhat low specificity of radiotracers and image resolution, have largely been overcome over the last 15Â years following the introduction of the hybrid SPECT/CT technology. SPECT/CT is redefining the diagnostic workup of patients with suspected or known infectious and inflammatory processes involving the musculoskeletal system as well as those with infectious and inflammatory disease located in various soft-tissue sites. Furthermore, it has been shown that in addition to improving diagnostic accuracy (by adding specificity to the inherent high sensitivity of single-photon emission tomography), SPECT/CT leads to changes in the subsequent clinical management of patients. The main indications for SPECT/CT in infection, as well as updated literature data on this topic, are presented in the following review

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“…Single Photon Emission Computed Tomography (SPECT)/computed tomography images ( Fig. 1) revealed an increased osteoblastic activity focused at the level of the vertebral body of S1 (red arrows), consistent with increased osteoblastic activity because of insufficient stabilizing function [1]. The second patient was a 58-year-old man with a lumbar fusion at L3-L5.…”

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confidence: 95%

Hybrid imaging (SPECT/computed tomography) with three-dimensional reconstruction: a new diagnostic tool for the study of low back pain after spinal fusion surgery

Rodríguez¹,

Jiménez²,

Aguilar³

et al. 2015

The Spine Journal

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SPECT/CT in patients with lower back pain after lumbar fusion surgery

Abstract: Because of its significantly higher accuracy compared with planar/SPECT, SPECT/CT should be the conventional nuclear medical procedure of choice for patients with lower back pain after LFS.

Cited by 30 publications

References 40 publications

Accuracy of bone SPECT/CT for identifying hardware loosening in patients who underwent lumbar fusion with pedicle screws

Accuracy of bone SPECT/CT for identifying hardware loosening in patients who underwent lumbar fusion with pedicle screws

SPECT/CT in infection and inflammation

Hybrid imaging (SPECT/computed tomography) with three-dimensional reconstruction: a new diagnostic tool for the study of low back pain after spinal fusion surgery

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