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Evaluation of Efficacy of Bone Scan With SPECT/CT in the Management of Low Back Pain

A Study Supported by Differential Diagnostic Local Anesthetic Blocks

Jain, Anuj MD*; Jain, Suruchi MD; Agarwal, Anil MD; Gambhir, Sanjay MD; Shamshery, Chetna MD; Agarwal, Amita MDS§

doi: 10.1097/AJP.0000000000000212
Original Articles

Introduction: Conventional radiologic modalities provide details only about the anatomic aspect of the various structures of the spine. Frequently the structures that show abnormal morphology may not be the cause of low back pain (LBP). Functional imaging in the form of bone scan along with single photon emission computerized tomography (SPECT/CT) may be helpful in identifying structures causing pain, whether morphologically normal or not. The objective of this study is to evaluate the role of bone scan with SPECT/CT in management of patients with LBP.

Methods: This is randomized double-blinded controlled study performed on 80 patients with LBP aged 20 to 80 years, ASA physical status I to III. Patients were randomized into bone scan and control groups consisting of 40 patients each. On the basis of the clinical features and radiologic findings a clinical diagnosis was made. After making a clinical diagnosis, the patients in bone scan group were subjected to bone scan with SPECT/CT. On the basis of the finding of the bone scan and SPECT/CT, a new working diagnosis was made and intervention was performed according to the new working diagnosis. Diagnostic blocks in the control group were given based on clinical diagnosis. Controlled comparative diagnostic blocks were performed with local anesthetic. The pain score just after the diagnostic block and at the time of discharge (approximately 4 h later) was recorded; the pain relief was recorded in percentage.

Results: In both the groups, sacroilitis was the most common diagnosis followed by facet joint arthropathy. The number of patients obtaining pain relief of >50% was significantly higher in the bone scan–positive group as compared with the control group. Three new clinical conditions were identified in the bone scan group. These conditions were multiple myeloma, avascular necrosis of the femoral head, and ankylosing spondylitis.

Conclusions: Bone scan with SPECT/CT was found to complement the clinical workup of patients with LBP. Inclusion of bone scan with SPECT/CT in LBP management protocol can help in making a correct diagnosis. At times it might bring out some new information that may be vital for further management of the patients with LBP.

*Department of Anesthesiology, Gandhi Medical College, Bhopal, Madhya Pradesh

Departments of Nuclear Medicine


§Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

Institutional Ethical Committee—IEC Code: 2013-187-IP-66.

The authors declare no conflict of interest.

Reprints: Anuj Jain, MD, Department of Anesthesiology, Gandhi Medical College, B118 New Minal Residency, JK Road, Bhopal, Madhya Pradesh, 462023, India (e-mail:

Received July 13, 2014

Received in revised form March 18, 2015

Accepted January 4, 2015

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.