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Abstract

Low back pain is a global problem affecting one in 10 people. The management of low back pain varies from conservative to more invasive methods with a spectacular increase in the number of patients undergoing spinal fusion surgery during the last decade. Conventional radiological and radionuclide studies are often used in the assessment of persistent or recurring pain after spinal surgery with several advantages and limitations related to each technique. This article reviews the key contribution of integrated bone SPECT/CT in evaluating patients with persistent or recurring pain after spinal surgery, focusing on spinal fusion. Current literature supports the use of bone SPECT/CT as an adjunct imaging modality and problem-solving tool in evaluating patients with suspicion of pseudarthrosis, adjacent segment degeneration, and hardware failure. The role of bone SPECT/CT in post-operative orthopaedic scenarios is evolving, and this review highlights the need for further research on the role of bone SPECT/CT in these patients.

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References

  1. Hoy D, March L, Brooks P, Blyth F, Woolf A, Bain C, et al. The global burden of low back pain: estimates from the global burden of disease 2010 study. Ann Rheum Dis. 2014;73(6):968–74. doi:10.1136/annrheumdis-2013-204428.

    Article  PubMed  Google Scholar 

  2. Maniadakis N, Gray A. The economic burden of back pain in the UK. Pain. 2000;84(1):95–103.

    Article  CAS  PubMed  Google Scholar 

  3. Williams AL, Gornet MF, Burkus JK. CT evaluation of lumbar interbody fusion: current concepts. AJNR Am J Neuroradiol. 2005;26(8):2057–66.

    PubMed  Google Scholar 

  4. Nizard RS, Wybier M, Laredo JD. Radiologic assessment of lumbar intervertebral instability and degenerative spondylolisthesis. Radiol Clin N Am. 2001;39(1):55–71. v-vi

    Article  CAS  PubMed  Google Scholar 

  5. Malhotra A, Kalra VB, Wu X, Grant R, Bronen RA, Abbed KM. Imaging of lumbar spinal surgery complications. Insights Imaging. 2015;6(6):579–90. doi:10.1007/s13244-015-0435-8.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Deyo RA. Back surgery--who needs it? N Engl J Med. 2007;356(22):2239–43. doi:10.1056/NEJMp078052.

    Article  CAS  PubMed  Google Scholar 

  7. Sumer J, Schmidt D, Ritt P, Lell M, Forst R, Kuwert T, et al. SPECT/CT in patients with lower back pain after lumbar fusion surgery. Nucl Med Commun. 2013;34(10):964–70. doi:10.1097/MNM.0b013e328363cf81.

    Article  PubMed  Google Scholar 

  8. Damgaard M, Nimb L, Madsen JL. The role of bone SPECT/CT in the evaluation of lumbar spinal fusion with metallic fixation devices. Clin Nucl Med. 2010;35(4):234–6. doi:10.1097/RLU.0b013e3181d18cdd.

    Article  PubMed  Google Scholar 

  9. Hibbs RA. An operation for progressive spinal deformities: a preliminary report of three cases from the service of the orthopaedic hospital. 1911. Clin Orthop Relat Res. 2007;460:17–20. doi:10.1097/BLO.0b013e3180686b30.

    Article  PubMed  Google Scholar 

  10. Albee FH. Transplantation of a portion of the tibia into the spine for Pott’s disease: a preliminary report 1911. Clin Orthop Relat Res. 2007;460:14–6. doi:10.1097/BLO.0b013e3180686a0f.

    Article  PubMed  Google Scholar 

  11. Kim HJ, Moon SH, Chun HJ, Kang KT, Kim HS, Moon ES, et al. Comparison of mechanical motion profiles following instrumented fusion and non-instrumented fusion at the L4-5 segment. Clin Invest Med. 2009;32(1):E64–9.

    Article  PubMed  Google Scholar 

  12. Nouh MR. Spinal fusion-hardware construct: basic concepts and imaging review. World J Radiol. 2012;4(5):193–207. doi:10.4329/wjr.v4.i5.193.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Rutherford EE, Tarplett LJ, Davies EM, Harley JM, King LJ. Lumbar spine fusion and stabilization: hardware, techniques, and imaging appearances. Radiographics. 2007;27(6):1737–49. doi:10.1148/rg.276065205.

    Article  PubMed  Google Scholar 

  14. Wu JC, Huang WC, Tsai HW, Ko CC, Wu CL, Tu TH, et al. Pedicle screw loosening in dynamic stabilization: incidence, risk, and outcome in 126 patients. Neurosurg Focus. 2011;31(4):E9. doi:10.3171/2011.7.FOCUS11125.

    Article  PubMed  Google Scholar 

  15. Gruskay JA, Webb ML, Grauer JN. Methods of evaluating lumbar and cervical fusion. Spine J. 2014;14(3):531–9. doi:10.1016/j.spinee.2013.07.459.

    Article  PubMed  Google Scholar 

  16. Lazennec JY, Brusson A, Folinais D, Zhang A, Pour AE, Rousseau MA. Measuring extension of the lumbar-pelvic-femoral complex with the EOS(R) system. European journal of orthopaedic surgery & traumatology : orthopedie traumatologie. 2015;25(6):1061–8. doi:10.1007/s00590-015-1603-8.

    Article  CAS  Google Scholar 

  17. Morvan G, Mathieu P, Vuillemin V, Guerini H, Bossard P, Zeitoun F, et al. Standardized way for imaging of the sagittal spinal balance. Eur Spine J. 2011;20(Suppl 5):602–8. doi:10.1007/s00586-011-1927-y.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Gates GF. SPECT bone scanning of the spine. Semin Nucl Med. 1998;28(1):78–94.

    Article  CAS  PubMed  Google Scholar 

  19. Saha S, Burke C, Desai A, Vijayanathan S, Gnanasegaran G. SPECT-CT: applications in musculoskeletal radiology. Br J Radiol. 2013;86(1031):20120519. doi:10.1259/bjr.20120519.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Patel ND, Broderick DF, Burns J, Deshmukh TK, Fries IB, Harvey HB, et al. ACR appropriateness criteria low back pain. J Am Coll Radiol. 2016;13(9):1069–78. doi:10.1016/j.jacr.2016.06.008.

    Article  PubMed  Google Scholar 

  21. Byrnes TJ, Xie W, Al-Mukhailed O, D’Sa A, Novruzov F, Casey AT, et al. Evaluation of neck pain with (18)F-NaF PET/CT. Nucl Med Commun. 2014;35(3):298–302. doi:10.1097/MNM.0000000000000044.

    Article  PubMed  Google Scholar 

  22. Gratz S, Dorner J, Oestmann JW, Opitz M, Behr T, Meller J, et al. 67Ga-citrate and 99Tcm-MDP for estimating the severity of vertebral osteomyelitis. Nucl Med Commun. 2000;21(1):111–20.

    Article  CAS  PubMed  Google Scholar 

  23. Adatepe MH, Powell OM, Isaacs GH, Nichols K, Cefola R. Hematogenous pyogenic vertebral osteomyelitis: diagnostic value of radionuclide bone imaging. J Nucl Med. 1986;27(11):1680–5.

    CAS  PubMed  Google Scholar 

  24. Morton KA, Jarboe J, Burke EM. Gallium-67 imaging in lymphoma: tricks of the trade. J Nucl Med Technol. 2000;28(4):221–32.

    CAS  PubMed  Google Scholar 

  25. Fuster D, Sola O, Soriano A, Monegal A, Setoain X, Tomas X, et al. A prospective study comparing whole-body FDG PET/CT to combined planar bone scan with 67Ga SPECT/CT in the diagnosis of spondylodiskitis. Clin Nucl Med. 2012;37(9):827–32. doi:10.1097/RLU.0b013e318262ae6c.

    Article  PubMed  Google Scholar 

  26. Smids C, Kouijzer IJ, Vos FJ, Sprong T, Hosman AJ, de Rooy JW, et al. A comparison of the diagnostic value of MRI and 18F-FDG-PET/CT in suspected spondylodiscitis. Infection. 2017;45(1):41–9. doi:10.1007/s15010-016-0914-y.

    Article  PubMed  Google Scholar 

  27. Nomayr A, Romer W, Strobel D, Bautz W, Kuwert T. Anatomical accuracy of hybrid SPECT/spiral CT in the lower spine. Nucl Med Commun. 2006;27(6):521–8.

    Article  PubMed  Google Scholar 

  28. Van den Wyngaert T, Strobel K, Kampen WU, Kuwert T, van der Bruggen W, Mohan HK, et al. The EANM practice guidelines for bone scintigraphy. Eur J Nucl Med Mol Imaging. 2016;43(9):1723–38. doi:10.1007/s00259-016-3415-4.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Hudyana H, Maes A, Vandenberghe T, Fidlers L, Sathekge M, Nicolai D, et al. Accuracy of bone SPECT/CT for identifying hardware loosening in patients who underwent lumbar fusion with pedicle screws. Eur J Nucl Med Mol Imaging. 2016;43(2):349–54. doi:10.1007/s00259-015-3158-7.

    Article  PubMed  Google Scholar 

  30. Heimburger C, FH, Charles YP, Steib J-P, Namer I-J, Rust E. Bone scan SPECT/CT for the diagnosis of late complications after spinal fusion: definition and evaluation of interpretation criteria. Médecine Nucléaire. 2015;39:105–21.

    Article  Google Scholar 

  31. Rager O, Schaller K, Payer M, Tchernin D, Ratib O, Tessitore E. SPECT/CT in differentiation of pseudarthrosis from other causes of back pain in lumbar spinal fusion: report on 10 consecutive cases. Clin Nucl Med. 2012;37(4):339–43. doi:10.1097/RLU.0b013e318239248b.

    Article  PubMed  Google Scholar 

  32. Cetinkal A, Kaya S, Kutlay M, Velioglu M, Urhan M, Colak A, et al. Can scintigraphy explain prolonged postoperative neck pain? Turk Neurosurg. 2011;21(4):539–44. doi:10.5137/1019-5149.JTN.4473-11.2.

    PubMed  Google Scholar 

  33. Gates GF, McDonald RJ. Bone SPECT of the back after lumbar surgery. Clin Nucl Med. 1999;24(6):395–403.

    Article  CAS  PubMed  Google Scholar 

  34. Albert TJ, Pinto M, Smith MD, Balderston RA, Cotler JM, Park CH. Accuracy of SPECT scanning in diagnosing pseudoarthrosis: a prospective study. J Spinal Disord. 1998;11(3):197–9.

    Article  CAS  PubMed  Google Scholar 

  35. Coric D, Branch CL Jr, Jenkins JD. Revision of anterior cervical pseudoarthrosis with anterior allograft fusion and plating. J Neurosurg. 1997;86(6):969–74. doi:10.3171/jns.1997.86.6.0969.

    Article  CAS  PubMed  Google Scholar 

  36. Even-Sapir E, Martin RH, Mitchell MJ, Iles SE, Barnes DC, Clark AJ. Assessment of painful late effects of lumbar spinal fusion with SPECT. J Nucl Med. 1994;35(3):416–22.

    CAS  PubMed  Google Scholar 

  37. Lusins JO, Danielski EF, Goldsmith SJ. Bone SPECT in patients with persistent back pain after lumbar spine surgery. J Nucl Med. 1989;30(4):490–6.

    CAS  PubMed  Google Scholar 

  38. Slizofski WJ, Collier BD, Flatley TJ, Carrera GF, Hellman RS, Isitman AT. Painful pseudarthrosis following lumbar spinal fusion: detection by combined SPECT and planar bone scintigraphy. Skelet Radiol. 1987;16(2):136–41.

    Article  CAS  Google Scholar 

  39. Chen WJ, Lai PL, Niu CC, Chen LH, Fu TS, Wong CB. Surgical treatment of adjacent instability after lumbar spine fusion. Spine (Phila Pa 1976). 2001;26(22):E519–24.

    Article  CAS  Google Scholar 

  40. Levin DA, Hale JJ, Bendo JA. Adjacent segment degeneration following spinal fusion for degenerative disc disease. Bull NYU Hosp Jt Dis. 2007;65(1):29–36.

    PubMed  Google Scholar 

  41. Pneumaticos SG, Chatziioannou SN, Hipp JA, Moore WH, Esses SI. Low back pain: prediction of short-term outcome of facet joint injection with bone scintigraphy. Radiology. 2006;238(2):693–8. doi:10.1148/radiol.2382041930.

    Article  PubMed  Google Scholar 

  42. Lee I, Budiawan H, Moon JY, Cheon GJ, Kim YC, Paeng JC, et al. The value of SPECT/CT in localizing pain site and prediction of treatment response in patients with chronic low back pain. J Korean Med Sci. 2014;29(12):1711–6. doi:10.3346/jkms.2014.29.12.1711.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Onsel C, Collier BD, Kir KM, Larson SJ, Meyer GA, Krasnow AZ, et al. Increased sacroiliac joint uptake after lumbar fusion and/or laminectomy. Clin Nucl Med. 1992;17(4):283–7.

    Article  CAS  PubMed  Google Scholar 

  44. Maigne JY, Planchon CA. Sacroiliac joint pain after lumbar fusion. A study with anesthetic blocks. Eur Spine J. 2005;14(7):654–8. doi:10.1007/s00586-004-0692-6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Chau AM, Mobbs RJ. Bone graft substitutes in anterior cervical discectomy and fusion. Eur Spine J. 2009;18(4):449–64. doi:10.1007/s00586-008-0878-4.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Iseda T, Nakano S, Suzuki Y, Miyahara D, Uchinokura S, Moriyama T, et al. Radiographic and scintigraphic courses of union in cervical interbody fusion: hydroxyapatite grafts versus iliac bone autografts. J Nucl Med. 2000;41(10):1642–5.

    CAS  PubMed  Google Scholar 

  47. Mohi Eldin MM, Ali AM. Lumbar transpedicular implant failure: a clinical and surgical challenge and its radiological assessment. Asian Spine J. 2014;8(3):281–97. doi:10.4184/asj.2014.8.3.281.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Smith JS, Shaffrey CI, Ames CP, Demakakos J, Fu KG, Keshavarzi S, et al. Assessment of symptomatic rod fracture after posterior instrumented fusion for adult spinal deformity. Neurosurgery. 2012;71(4):862–8. doi:10.1227/NEU.0b013e3182672aab.

    Article  PubMed  Google Scholar 

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Al-Riyami, K., Gnanasegaran, G., Van den Wyngaert, T. et al. Bone SPECT/CT in the postoperative spine: a focus on spinal fusion. Eur J Nucl Med Mol Imaging 44, 2094–2104 (2017). https://doi.org/10.1007/s00259-017-3765-6

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