Preoperative Single Photon Emission Computed Tomography Imaging as a Tool for Surgical Planning in Patients With Axial Neck and Back Pain

Abstract

Abstract INTRODUCTION Single Photon Emission Computed Tomography (SPECT) imaging has recently been employed to identify pain generators in patients with axial neck and back pain, indicating potential sites of degeneration. We describe the largest series to date of patients with axial neck or back who underwent preoperative SPECT imaging for surgical planning. METHODS A retrospective medical and imaging record review was conducted to identify patients who underwent SPECT or SPECT/CT studies between January 2014 and May 2018. Surgical criteria included symptoms of intractable back or neck pain and evidence of degenerative pathology on SPECT imaging. Only those patients who subsequently underwent surgery on a spinal level associated with increased radiotracer uptake were included in the analysis. Patient baseline and demographic information, and data pertaining to SPECT imaging, surgical planning, and postoperative care was collected and analyzed. RESULTS A total of 23 patients with an average age at surgery of 60.0+/−11.0 yr were included. About 15 patients (65%) were male. A total of 53 spinal levels were treated, with an average of 2.30 levels treated per patient. All patients underwent fusion surgery, either lumbar (14) with interbody fusion most commonly employed (64.2%) or cervical (9) with anterior cervical discectomy and fusion (66.6%) most common. Average LOS was 3.45+/−2.32 d. One patient developed a wound infection postoperatively, requiring readmission. At 3-mo follow-up, 18 patients (78.3%) reported clinical improvement in pain. About 11 patients (47.8%) reported complete symptom resolution at 6-mo follow-up. At 1 yr postoperatively, 19 patients (82.6%) reported some relief of their symptoms following surgery. CONCLUSION This is the largest series to date describing patients with axial neck and back pain who underwent preoperative SPECT imaging and subsequent surgical intervention on the affected spinal levels. Our results demonstrate that SPECT imaging may be a useful adjunct to guide surgical planning, resulting in substantial clinical improvement following surgery.