199. Identifying the source of neck pain with single photon emission computed tomography/computed tomography (SPECT/CT)

Abstract

BACKGROUND CONTEXT Diagnosing and treating nonradicular axial neck pain remains difficult. While multiple conventional imaging modalities exist, eg,roentgenograms (X-ray images), computed tomography (CT) scans, magnetic resonance images (MRI), none reliably diagnose the foci for uncomplicated neck pain. Further, facet injections, medial branch blocks and radiofrequency ablations are also variably diagnostic. Hybrid imaging, single photon emission computed tomography/ computed tomography (SPECT/CT) scans may assist in diagnosing etiologies for axial neck pain. PURPOSE To evaluate the diagnostic potential of SPECT/CT in patients with nonradicular axial neck pain. STUDY DESIGN/SETTING A retrospective cohort study performed at a single tertiary care center. PATIENT SAMPLE One hundred and thirteen unique patients were enrolled. All patients received SPECT/CT imaging for no-radicular axial neck pain between 2009-2015 and subsequently underwent procedural intervention at our institution's chronic pain center. Exclusion criteria included prior cervical injection or surgery at a level identified as a potential pain foci on SPECT/CT scan. OUTCOME MEASURES Percentage of pain relief within 24 hours after facet injection, medial branch block or radiofrequency ablation. A positive response was defined as a minimum of fifty percent reduction in pain. METHODS One hundred and seventy-nine patients diagnosed with nonradicular, axial neck pain who received SPECT/CT scans during their workup were identified. One hundred and thirteen of these had no prior intervention at the level of interest and met inclusion criteria. All patients meeting inclusion criteria were referred by our institution's orthopedic and neurosurgical spine providers for diagnostic/ therapeutic intervention by our chronic pain specialists. The cervical joint of intervention was determined based on interpretation of SPECT/CT imaging. Ultimately, the site of intervention was determined based on the clinical examination and image interpretation of the chronic pain providers.Two groups were formed. The first group (Group 1) consisted of 90 patients with an intervention occurring at the level identified on SPECT/CT. The second group (Group 2) consisted of 23 patients with an intervention at a level not indicated by SPECT/CT. A positive response was set at a minimum of 50% reduction in pain within 24 hours of intervention. Data were analyzed using a Chi-square statistic. SPSS (IBM Corp. IBM SPSS Version 24.0) was used for all analyses. RESULTS Sixty-two of 90 patients (68.9%) in Group 1 positively responded to intervention whereas only 6 of 23 patients (26.1%) in Group 2 did (p = 0.0002). CONCLUSIONS In patients receiving SPECT/CT, intervening on a level identified by the imaging study positively correlated with pain reduction. This suggests a role for SPECT/CT in diagnosing therapeutic targets for axial neck pain. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.