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SPECT/CT in patients with lower back pain after lumbar fusion surgery

Sumer, Johannesa; Schmidt, Danielaa; Ritt, Philippa; Lell, Michaelb; Forst, Raimundc; Kuwert, Torstena; Richter, Richardc

Nuclear Medicine Communications: October 2013 - Volume 34 - Issue 10 - p 964–970
doi: 10.1097/MNM.0b013e328363cf81
Original Articles

Objective: The aim of the study was to investigate the incremental diagnostic value of skeletal hybrid imaging with single-photon emission computed tomography and X-ray computed tomography (SPECT/CT) over conventional nuclear medical imaging in patients with lower back pain after lumbar fusion surgery (LFS).

Patients and methods: This retrospective study comprised 37 patients suffering from lower back pain after LFS in whom three-phase planar bone scintigraphies of the lumbar spine including SPECT/CT of that region had been performed. The findings visible on these imaging data sets were classified into the following five diagnostic categories: (a) metal loosening; (b) insufficient stabilizing function of the metal implants indicated by metabolically active facet joint arthritis and/or intervertebral osteochondrosis in the instrumented region; (c) adjacent instability defined as metabolically active degenerative disease in the segments adjacent to the instrumented region; (d) indeterminate; and (e) normal.

Results: In the case of eight patients no lesions were visible on their planar scintigraphy and SPECT (planar/SPECT) or SPECT/CT images. In the remaining 29 patients, planar/SPECT disclosed 62 pathological foci of uptake within the graft region and SPECT/CT revealed 55. The rate of reclassification by SPECT/CT compared with planar/SPECT was 5/12 for lesions categorized as metal loosening by planar/SPECT, 16/29 for foci with a planar/SPECT diagnosis of insufficient stabilizing function, 7/20 when the planar/SPECT diagnosis had been adjacent instability, and 1/1 for the lesions indeterminate on planar/SPECT. Two lesions had been detected on SPECT/CT only. The overall rate of reclassification was 45.2% (28/62) (95% confidence interval, 33.4–57.5%).

Conclusion: Because of its significantly higher accuracy compared with planar/SPECT, SPECT/CT should be the conventional nuclear medical procedure of choice for patients with lower back pain after LFS.

aClinic of Nuclear Medicine

bInstitute of Radiology, Friedrich-Alexander-University Erlangen-Nürnberg

cClinic of Orthopedic Surgery, Waldkrankenhaus St. Marien, Erlangen, Germany

Correspondence to Torsten Kuwert, MD, Clinic of Nuclear Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany Tel: +49 131 853 411; fax: +49 131 853 9262; e-mail:

Received November 19, 2012

Accepted June 2, 2013

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins