Appearance of facet joint syndrome in a case of chronic sacroiliitis: Evidenced from quantitative sacroiliac scintigraphy and dual images of SPECT-CT

Abstract

Lower back pain (LBP) is a global health concern with increasing prevalence, projected to reach 843 million cases by 2050. Lumbar facet joint (LFJ) syndrome contributes significantly to LBP, impacting patient quality of life. Despite its prevalence, a gold standard for accurate and noninvasive diagnosis of LBP has not yet been established, leading to underdiagnosis and inadequate treatment. This case report presents a 57-year-old woman diagnosed with LFJ syndrome and mild sacroiliitis through single-photon emission computed tomography- computed tomography (SPECT-CT) and quantitative sacroiliac scintigraphy (QSS). The patient presented with persistent LBP and hip pain without history of trauma or surgery. Clinical examination revealed lumbar tenderness, limited mobility, and positive Fortin and STORK tests. Whole body bone scan (WBBS) revealed tracer uptake at the sacroiliac (SI) joints and multiple spinal levels, particularly L3-L4. Hybrid SPECT-CT imaging showed heightened bone activity on lumbar spine, confirming degenerative arthropathy of the L3-L4 facet joints, in contrast with minimal evidence obtained from plain radiography and CT images. Furthermore, combining results from SPECT-CT and borderline sacroiliac indices from QSS indicate the presence of chronic degenerative sacroiliitis. Identifying the source of LBP remains challenging. SPECT-CT emerges as a valuable tool for comprehensive evaluation of LBP by combining anatomical and functional imaging of target tissues, allowing increased foci localization and accuracy of diagnosis. QSS can also be utilized as a complement in identifying the presence of chronic lesions of the SI joints. These promising results open opportunities for more research on the efficacy of combined morphological and functional imaging, as well as sacroiliac indices as a complementary diagnostic tool.