SPECT/CT Imaging Helps Choose Best Treatment for Low Back Pain

Low back pain is not only excruciating but also debilitating for numerous sufferers. Regrettably, not everyone responds to treatment. A molecular imaging scan in addition to a standard bone scan can provide the needed information about the physiologic health of the spine to choose the most suitable pain-killing treatment strategy for low back pain sufferers.

Traditional imaging methods including X-ray, computed tomography (CT), and even magnetic resonance imaging (MRI) show the structure of the bone; however, the source of the pain is frequently not directly related to noticeable structural changes. The hybrid molecular imaging approach called single photon emission computed tomography, combined with computed tomography (SPECT/CT), is able to go beyond structure to target the slight physiologic mechanisms causing the pain—for instance, inflammation or infection. With more clinical confidence, interventional specialists can offer a range of treatments to relieve their patients’ pain.

“Low back pain is an extremely common problem that affects most people at some point in their life,” said Dr. Suruchi Jain, coauthor of the study conducted at the Sanjay Gandhi Institute of Medical Sciences (Lucknow, India). “Inclusion of SPECT/CT with conventional bone scan could help reduce unnecessary treatments and provide vital information for the proper management of patients in pain.”

The objective of the study was to compare the disparity in pain relief following clinical pain management between two groups of patients. A total of 80 adults between the ages of 20 and 80 years of age were included in the randomized, double-blind trial. One group underwent conventional bone scans with the addition of SPECT/CT imaging, and a second group acted as a control, with no imaging provided prior to intervention. Patients were assessed on a scale according to percentage of pain relief compared to their baseline level prior to treatment.

Patients with 50% or greater pain relief were much more likely to be in the bone scan group. A total of 28 patients in the bone scan group achieved between 70% and 100% pain relief, compared to only 10 study participants in that range in the control group. Clinical diagnosis was altered for 23 out of 40 patients in the bone scan group, and three new conditions were revealed as a result of the bone scan. This evidence could optimize access to SPECT/CT for these patients.

“The findings of this study suggest that incorporation of a bone scan with SPECT/CT in work-ups of low backache patients could lead to more widespread use of this nuclear medicine procedure in the future by increasing the confidence level of pain-treating physicians prior to interventions, thus improving their outcome,” Dr. Jain concluded.

Researchers presented their findings at the Society of Nuclear Medicine and Molecular Imaging’s 2014 annual meeting, held June 7-11, 2014, in St. Louis (MO, USA).

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Sanjay Gandhi Institute of Medical Sciences