Abstract
Mechanical low back pain is a common indication for Nuclear Medicine imaging. Whole-body bone scan is a very sensitive but poorly specific study for the detection of metabolic bone abnormalities. The accurate localisation of metabolically active bone disease is often difficult in 2D imaging but single photon emission computed tomography/computed tomography (SPECT/CT) allows accurate diagnosis and anatomic localisation of osteoblastic and osteolytic lesions in 3D imaging. We present a clinical case of a patient referred for evaluation of chronic lower back pain with no history of trauma, spinal surgery, or cancer. Planar whole-body scan showed heterogeneous tracer uptake in the lumbar spine with intense localisation to the right lateral aspect of L3. Integrated SPECT/CT of the lumbar spine detected active bone metabolism in the right L3/L4 facet joint in the presence of minimal signs of degenerative osteoarthrosis on CT images, while a segment demonstrating more gross degenerative changes was more quiescent with only mild tracer uptake. The usefulness of integrated SPECT/CT for anatomical and functional assessment of back pain opens promising opportunities both for multi-disciplinary clinical assessment and treatment for manual therapists and for research into the effectiveness of manual therapies.
Highlights
The concept of lumbar facet joints causing or contributing to mechanical low back pain syndromes has been debated in the health care literature for decades [1]
We present here the case of a patient with radiological signs of marked lumbosacral junction facet joint osteoarthrosis and clinical symptoms supportive of pathology in this region but with SPECT/CT findings suggestive of an active bony lesion at a more remote spinal segment
Heterogeneous tracer uptake was noted at multiple spinal levels with marked increased focal tracer uptake in the right lateral aspect of L3 (Figure 1)
Summary
The concept of lumbar facet joints causing or contributing to mechanical low back pain syndromes has been debated in the health care literature for decades [1]. Practitioners of the various manual therapies commonly treat patients presenting with low back pain but are faced with the diagnostic challenge of trying to identify a tissue source of low back pain. While this complaint may be the result of any of a number of pathologies, the vast majority of low back pain falls under the diagnostic umbrella of ‘’ mechanical low back pain ‘’ [2]. History The patient in question was a 45-year-old Hispanic female who had lived in Canada for the previous 11 years She reported a long history of manual labour and
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