Skip to main content

Advertisement

SpringerLink
Log in

Is hybrid imaging (SPECT/CT) a useful adjunct in the management of suspected facet joints arthropathy?

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study was to assess the value of SPECT/CT imaging in patients with chronic spinal pain.

Methods

This was a retrospective consecutive study. Patients with chronic neck or back pain from outpatient spinal clinics with clinical features raising the possibility of a facetogenic pain generator and non-conclusive MRI/CT findings were included. Imaging was performed on a dual-headed, hybrid SPECT/CT γ-camera with a low-dose CT transmission scan acquired after the SPECT study. SPECT/CT studies were viewed in the coronal, axial, and sagittal planes and in 3-dimensional mode. Descriptive statistical analysis was performed.

Results

Seventy-two patients were included (37 females, 35 males, mean age of 53.9 years). There were 25 cervical spine scans and 49 lumbar spine scans. In the cervical spine group, 13 (52 %) patients had scintigraphically active cervical facet joint arthropathy and ten (36 %) had other pathology identified. Two thirds of patients diagnosed with facet joint arthropathy received steroid guided injections following their scans. In the lumbar spine group 34 (69.4 %) patients had scintigraphically active lumbar facet joint arthropathy and eight had other pathology identified. Twenty patients (58.8 %) diagnosed with facet joint arthropathy subsequently received steroid guided injections.

Conclusions

Hybrid SPECT/CT imaging identified potential pain generators in 92 % of cervical spine scans and 86 % of lumbar spine scans. The scan precisely localised SPECT positive facet joint targets in 65 % of the referral population and a clinical decision to inject was made in 60 % of these cases.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Bogduk N (2005) The zygapophysial joints. In Clinical Anatomy of the Lumbar Spine and Sacrum. 3rd edn. Churchill Living stone, New York

  2. Manchikanti L, Boswell MV, Singh V, Pampati V, Damron KS, Beyer CD (2004) Prevalence of facet joint pain in chronic spinal pain of cervical, thoracic, and lumbar regions. BMC Musculoskelet Disord 5:15

    Article  PubMed  Google Scholar 

  3. Schwarzer AC, Aprill CN, Derby R, Fortin J, Kine G, Bogduk N (1994) Clinical features of patients with pain stemming from the lumbar zygapophysial joints. Is the lumbar facet syndrome a clinical entity? Spine 19:1132–1137

    Article  PubMed  CAS  Google Scholar 

  4. Fukui S, Ohseto K, Shiotani M, Ohno K, Karasawa H, Naganuma Y (1997) Distribution of referral pain from the lumbar zyg apophyseal joints and dorsal rami. Clin J Pain 13:303–307

    Article  PubMed  CAS  Google Scholar 

  5. Windsor RE, King FJ, Roman SJ, Tata N, Cone-Sullivan LA, Thampi S, Acebey M, Gilhool JJ, Rao R, Sugar R (2002) Electrical stimulation induced lumbar medial branch referral patterns. Pain Physician 5:347–353

    PubMed  Google Scholar 

  6. Boswell MV, Shah RV, Everett CR, Sehgal N, Mckenzie-Brown AM, Abdi S, Bowman RC, Deer TR, Datta S, Colson JD, Spillane WF, Smith HS, Lucas-Levin LF, Burton AW, Chopra P, Staats PS, Wasserman RA, Manchikanti L (2005) Interventional techniques in the management of chronic spinal pain: Evidence-based practice guidelines. Pain Physician 8:1–47

    PubMed  Google Scholar 

  7. Bogduk N (2008) Evidence-informed management of chronic low back pain with facet injections and radiofrequency neurotomy. Spine J 8:56–64

    Article  PubMed  Google Scholar 

  8. Sehgal N, Dunbar EE, Shah RV, Colson JD (2007) Systematic review of diagnostic utility of facet (zygapophysial) joint injections in chronic spinal pain: an update. Pain Physician 10:213–228

    PubMed  Google Scholar 

  9. Delbeke D, Schöder H, Martin WH, Wahl RL (2009) Hybrid imaging (SPECT/CT and PET/CT): improving therapeutic decisions. Semin Nucl Med 39:308–340

    Article  PubMed  Google Scholar 

  10. Filippi L, Schillaci O (2006) Usefulness of hybrid SPECT/CT in 99mTc-HMPAO-labeled leukocyte scintigraphy for bone and joint infections. J Nucl Med 47:1908–1913

    PubMed  CAS  Google Scholar 

  11. Utsunomiya D, Shiraishi S, Imuta M, Tomiguchi S, Kawanaka K, Morishita S, Awai K, Yamashita Y (2006) Added value of SPECT/CT fusion in assessing suspected bone metastasis: comparison with scintigraphy alone and nonfused scintigraphy and CT. Radiology 238:264–271

    Article  PubMed  Google Scholar 

  12. Dolan AL, Ryan PJ, Arden NK, Stratton R, Wedley JR, Hamann W, Fogelman I, Gibson T (1996) The value of SPECT scans in identifying back pain likely to benefit from facet joint injection. Br J Rheumatol 35:1269–1273

    Article  PubMed  CAS  Google Scholar 

  13. Dutton JA, Hughes SP, Peters AM (2000) SPECT in the management of patients with back pain and spondylolysis. Clin Nucl Med 25:93–96

    Article  PubMed  CAS  Google Scholar 

  14. Holder LE, Machin JL, Asdourian PL, Links JM, Sexton CC (1995) Planar and high-resolution SPECT bone imaging in the diagnosis of facet syndrome. J Nucl Med 36:37–44

    PubMed  CAS  Google Scholar 

  15. Horger M, Bares R (2006) The role of single-photon emission computed tomography/computed tomography in benign and malignant bone disease. Semin Nucl Med 36:286–294

    Article  PubMed  Google Scholar 

  16. Husarik DB, Steinert HC (2007) Single-photon emission computed tomography/computed tomography for sentinel node mapping in breast cancer. Semin Nucl Med 37:29–33

    Article  PubMed  Google Scholar 

  17. Krausz Y, Israel O (2006) Single-photon emission computed tomography/computed tomography in endocrinology. Semin Nucl Med 36:267–274

    Article  PubMed  Google Scholar 

  18. Hirschmann MT, Davda K, Iranpour F, Rasch H, Friederich NF (2011) Combined single photon emission computerised tomography and conventional computerised tomography (SPECT/CT) in patellofemoral disorders: a clinical review. Int Orthop 35:675–680

    Article  PubMed  Google Scholar 

  19. Hirschmann MT, Mathis D, Rasch H, Amsler F, Friederich NF, Arnold MP (2012) SPECT/CT tracer uptake is influenced by tunnel orientation and position of the femoral and tibial ACL graft insertion site. Int Orthop. doi:10.1007/s00264-012-1704-5 [Epub ahead of print]

  20. McDonald M, Cooper R, Wang MY (2007) Use of computed tomography-single-photon emission computed tomography fusion for diagnosing painful facet arthropathy. Technical note. Neurosurg Focus 22:E2

    Article  PubMed  Google Scholar 

  21. Strobel K, Burger C, Seifert B (2007) Husarik DB, Soyka JD, Hany TF (2007) Characterization of focal bone lesions in the axial skeleton: performance of planar bone scintigraphy compared with SPECT and SPECT fused with CT. AJR Am J Roentgenol 188:W467–W474

    Article  PubMed  Google Scholar 

  22. Strobel K, Burger C, Seifert B, Husarik DB, Soyka JD, Hany TF (2007) Characterization of focal bone lesions in the axial skeleton: performance of planar bone scintigraphy compared with SPECT and SPECT fused with CT. AJR Am J Roentgenol 188:467–474

    Article  Google Scholar 

  23. Gorbach C, Schmid MR, Elfering A, Hodler J, Boos N (2006) Therapeutic efficacy of facet joint blocks. AJR Am J Roentgenol 186:1228–1233

    Article  PubMed  Google Scholar 

  24. Savigny P, Kuntze S, Watson P, Underwood M, Ritchie G, Cotterell M, Hill D, Browne N, Buchanan E, Coffey P, Dixon P, Drummond C, Flanagan M, Greenough C, Griffiths M, Halliday-Bell J, Hettinga D, Vogel S, Walsh D (2009) Low back pain: early management of persistent non-specific low back pain. National Collaborating Centre for Primary Care and Royal College of General Practitioners, London

    Google Scholar 

  25. Carrino JA, Lurie JD, Tosteson AN, Tosteson TD, Carragee EJ, Kaiser J, Grove MR, Blood E, Pearson LH, Weinstein JN, Herzog R (2009) Lumbar spine: reliability of MR imaging findings. Radiology 250:161–170

    Article  PubMed  Google Scholar 

  26. Even-Sapir E (2005) Imaging of malignant bone involvement by morphologic, scintigraphic, and hybrid modalities. J Nucl Med 46:1356–1367

    PubMed  Google Scholar 

  27. Papathanassiou D, Bruna-Muraille C, Jouannaud C, Gagneux-Lemoussu L, Eschard JP, Liehn JC (2009) Single-photon emission computed tomography combined with computed tomography (SPECT/CT) in bone diseases. Joint Bone Spine 76:474–480

    Article  PubMed  Google Scholar 

  28. Horger M, Eschmann SM, Pfannenberg C, Vonthein R, Besenfelder H, Claussen CD, Bares R (2004) Evaluation of combined transmission and emission tomography for classification of skeletal lesions. AJR Am J Roentgenol 183:655–661

    Article  PubMed  Google Scholar 

  29. Tharp K, Israel O, Hausmann J, Bettman L, Martin WH, Daitzchman M, Sandler MP, Delbeke D (2004) Impact of 131I-SPECT/CT images obtained with an integrated system in the follow-up of patients with thyroid carcinoma. Eur J Nucl Med Mol Imaging 31:1435–1442

    Article  PubMed  CAS  Google Scholar 

  30. Even-Sapir E, Keidar Z, Sachs J, Engel A, Bettman L, Gaitini D, Guralnik L, Werbin N, Iosilevsky G, Israel O (2001) The new technology of combined transmission and emission tomography in evaluation of endocrine neoplasms. J Nucl Med 42:998–1004

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Nuclear Medicine, Royal Free Hospital, Pond Street, London, NW3 2QG, UK

    Hosam E. Matar, Shaunak Navalkissoor & Ann-Marie Quigley

  2. Department of Radiology, The Whittington Hospital, Magdala Avenue, London, N19 5NF, UK

    Marko Berovic

  3. Department of Orthopaedic Surgery, The Whittington Hospital, Magdala Avenue, London, N19 5NF, UK

    Rohit Shetty

  4. Department of Orthopaedic Surgery, Royal Free Hospital, Pond Street, London, NW3 2QG, UK

    Nicholas Garlick

  5. The Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK

    Adrian T. H. Casey

Authors
  1. Hosam E. Matar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shaunak Navalkissoor
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marko Berovic
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rohit Shetty
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nicholas Garlick
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Adrian T. H. Casey
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ann-Marie Quigley
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hosam E. Matar.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Matar, H.E., Navalkissoor, S., Berovic, M. et al. Is hybrid imaging (SPECT/CT) a useful adjunct in the management of suspected facet joints arthropathy?. International Orthopaedics (SICOT) 37, 865–870 (2013). https://doi.org/10.1007/s00264-013-1811-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-013-1811-y

Keywords

Search

Navigation