Does SPECT/CT Imaging Paired with Clinical Evaluation Provide Prognostic Utility for Short-term Outcomes of Targeted Interventions for Chronic Axial Spine Pain? An Exploratory Study

  • Zachary L. McCormick, MD University of Utah
  • Stuart Willick, MD University of Utah
  • Zach Beresford, MD
  • Aaron Conger, DO University of Utah
  • Richard Kendall, DO University of Utah
  • Lubdha Shah, MD University of Utah
  • Troy Hutchins, MD University of Utah
  • Kathryn Morton, MD University of Utah
Keywords: bisphosphonate, SPECT/CT, facet, zygapophyseal, targeted, injection

Abstract

Objectives
To determine short-term pain outcomes associated with targeted intervention, guided by a concordant clinical evaluation and Tc-99m methylenediphosphonate SPECT/CT bone scan findings in patients with chronic recalcitrant axial spine pain.
Methods
Medical records were reviewed of consecutive patients who underwent SPECT/CT as part of their evaluation between April, 2007 and August, 2012. Corticosteroid injection or radiofrequency ablation (RFA) was performed based on concordance between clinical evaluation and SPECT/CT findings. The primary outcome was the proportion of patients with >50% pain reduction at >4 weeks after the intervention.
Results
Of 98 patients who underwent SPECT/CT, 77 (79%) underwent targeted intervention. A responder rate (>50% pain relief) of 50% (95% CI 35-65%) and 60% (95% CI 35-85%) for facet and non-facet axial spinal corticosteroid injections >4 weeks post-intervention, respectively, was observed. MBN RFA demonstrated a responder rate (>80% pain relief) of 78% (95% CI 59-97%) at least 4 weeks post-treatment; 67% (95% CI 45-88%) of patients who underwent MBN RFA following this selection protocol reported 100% pain relief at least 4 weeks post treatment.
Conclusions
In this single center retrospective study, SPECT/CT interpreted in the context of the clinical evaluation provided value as a prognostic tool for targeted interventions in patients with chronic, axial spine pain. However, prospective, multi-center study with long-term outcome assessment including defining means of quantifying clinically meaningful SPECT/CT findings is needed.

Published
2019-05-24
Section
Articles