Abstract
BackgroundDiagnosis of the cause of low back pain in the presence of degenerative spine disease using conventional imaging techniques, especially in elderly individuals, is challenging. Our aim was to describe our use of bone scintigraphy with single photon emission computed tomography (bone SPECT/CT) in the assessment of low back pain in elderly patients with degenerative lumbar spine disease, underlining the clinical utility of bone SPECT/CT imaging in this clinical population to inform diagnosis and treatment.MethodsBetween January 2016 and December 2017, we used bone SPECT/CT to successfully identify the cause of low back pain in five elderly patients. All patients had been scheduled for extensive spinal fusion surgery based on conventional imaging (plain radiography, computed tomography, and magnetic resonance).ResultsAfter diagnosis using bone SPECT/CT, three patients underwent spinal fusion at 1–2 levels with specific degenerative disk and joint disease, with the other two patients successfully treated using a conservative approach for a non-traumatic insufficiency fracture of the endplate of the L4 vertebral body and a fracture of the transverse process of L3. Clinically meaningful decrease in pain and fracture healing were obtained with conservative treatment.ConclusionBone SPECT/CT was useful to identify the specific cause of pain in elderly patients with lumbar degenerative disease and to provide appropriate treatment, avoiding the unnecessary use of invasive spinal fusion surgery. Therefore, the clinical utility of bone SPECT/CT is potentially high as it improves diagnosis and lowers the risk of inappropriate invasive spinal surgery.
Highlights
Diagnosis of the cause of low back pain in the presence of degenerative spine disease using conventional imaging techniques, especially in elderly individuals, is challenging
Between January 2016 and December 2017, we used bone SPECT/Computed tomography (CT) to identify the primary cause of pain among five patients with degenerative or aging-associated disorders of the lumbar spine (Table 1)
All five patients presented with severe Low back pain (LBP), which had been incorrectly diagnosed based on plain radiographs, Magnetic resonance (MR), and CT imaging obtained at our institution or others
Summary
Diagnosis of the cause of low back pain in the presence of degenerative spine disease using conventional imaging techniques, especially in elderly individuals, is challenging. Our aim was to describe our use of bone scintigraphy with single photon emission computed tomography (bone SPECT/CT) in the assessment of low back pain in elderly patients with degenerative lumbar spine disease, underlining the clinical utility of bone SPECT/CT imaging in this clinical population to inform diagnosis and treatment. The recent introduction of bone scintigraphy with single photon emission computed tomography (bone SPECT/CT) as an imaging modality allows assessment of both morphology and physiology in a single study. CT images provide a precise anatomical localization of the site(s) of radiotracer uptake, despite spinal degenerative changes, which improves the accuracy and specificity of the diagnosis of LBP [8, 9].
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