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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