SPECT/CT imaging for diagnosis and management of failed cervical spine surgery syndrome

Abstract

ObjectivesTo investigate the use of SPECT/CT imaging in patients who had postoperative neck pain after cervical fusion procedures and to devise an appropriate treatment strategy for this patient population. Methods23 patients (8 male, 15 female) with postoperative neck pain were included in this study. Average age of patient was 60 ± 2.11 years. All patients underwent prior cervical fusion surgery and after at least 1 year of postoperative observation continue to suffer unremitting and debilitating neck pain with or without non-dermatomal arm pain. All patients underwent postoperative imaging studies including MRI and CT scan. If no clear origin of pain was detected, SPECT/CT imaging was obtained. Average number of years from prior surgery to SPECT/CT scanning was 5.5 ± 1.1 years. Preoperative VAS score averaged 8.39 ± 0.29 for this patient cohort. ResultsOf the 23 patients who underwent SPECT/CT due to inadequacy of diagnosis based on anatomic studies, 15 patients underwent cervical spine surgery. Eight patients were referred to pain management based on SPECT/CT imaging and clinical symptomatology. 6 surgeries were anterior and 9 were posterior. Last follow-up evaluation after revision surgery was at 12 months. Average VAS scores declined after revision surgery to 4.74 ± 0.5. ConclusionIdentification of postoperative spinal surgery pain is necessary to design the appropriate intervention. Patients seen in our practice suffering from failed cervical spinal surgery syndrome and offered SPECT/CT imaging leading to the identification of a focus of surgical treatment experienced significant reduction in VAS scores after revision surgery.