Value of Bone Scintigraphy and Single Photon Emission Computed Tomography (SPECT) in Lumbar Facet Disease and Prediction of Short-term Outcome of Ultrasound Guided Medial Branch Block with Bone SPECT

Abstract

BackgroundFacet joint disease plays a major role in axial low-back pain. Few diagnostic tests and imaging methods for identifying this condition exist. Single photon emission computed tomography (SPECT) is reported that it has a high sensitivity and specificity in diagnosing facet disease. We prospectively evaluated the use of bone scintigraphy with SPECT for the identification of patients with low back pain who would benefit from medial branch block.MethodsSPECT was performed on 33 patients clinically suspected of facet joint disease. After SPECT, an ultrasound guided medial branch block was performed on all patients. On 28 SPECT-positive patients, medial branch block was performed based on the SPECT findings. On 5 negative patients, medial branch block was performed based on clinical findings. For one month, we evaluated the patients using the visual analogue scale (VAS) and Oswestry disability index. SigmaStat and paired t-tests were used to analyze patient data and compare results.ResultsOf the 33 patients, the ones who showed more than 50% reduction in VAS score were assigned 'responders'. SPECT positive patients showed a better response to medial branch blocks than negative patients, but no changes in the Oswestry disability index were seen.ConclusionsSPECT is a sensitive tool for the identification of facet joint disease and predicting the response to medial branch block.

Frequency of Discordance between Facet Joint Activity on Technetium Tc99m Methylene Diphosphonate SPECT/CT and Selection for Percutaneous Treatment at a Large Multispecialty Institution

“…Prior reports have found that strictly targeting facet joints with increased 99m Tc MDP activity is predictive of a positive response to percutaneous treatment [4][5][6] and that use of bone scans can decrease the number of treated facet joints. 4 However, in the current retrospective review of our institution, this association did not translate into actual clinical practice for patients in whom 99m Tc MDP SPECT/CT examinations were ordered specifically to identify pain generators, mostly by pain physicians.…”

“…Anatomic co-localization is important because facet joints are anatomically juxtaposed, the number of vertebral bodies is variable, and transitional lumbosacral vertebral bodies are present in 4%-30% of patients. 8 Previously, criteria for active facet joints were either not clearly defined [5][6] or were arbitrarily designated as those greater than the adjacent vertebral body, 4 which could be problematic because vertebral body activity at the levels of degenerative spinal disease is highly variable in our experience. In addition, prior studies have included patients and proceduralists who were not clearly blinded, 4-6 had widely overlapping statistical error measurements between treatment and control groups, 4 and/or used facet joint injections/single medial branch blocks.…”

“…In addition, prior studies have included patients and proceduralists who were not clearly blinded, 4-6 had widely overlapping statistical error measurements between treatment and control groups, 4 and/or used facet joint injections/single medial branch blocks. [4][5][6] A prior case series analysis describes a positive response to treatment of facet joints selected with 99m Tc SPECT/CT where the patients and proceduralists were not clearly blinded, there was no control group, and comparative medial branch blocks were not used. 9 Although facet joint injections remain a treatment option in routine clinical practice, these have a 32% placebo rate.…”

“…[1][2][3] Prior studies suggest that technetium Tc99m methylene diphosphonate ( 99m Tc MDP) bone scan activity can predict if a facet joint is painful and if there will be a positive response to percutaneous intervention targeted specifically to active facet joints. [4][5][6] These prior studies used strict treatment of every facet joint with increased radiotracer activity on bone scan, [4][5][6] concluding that 99m Tc MDP SPECT can decrease the number of treated facet joints. 4 However, those results can only be applicable if this is used in clinical practice and is feasible.…”

Skeletal SPECT/CT: a review

“…Additional data on the use of stand-alone SPECT also point in this direction [42][43][44]. In a further publication, however, Lehmann et al [45], in a group of 74 patients, analyzed the relationship between the localization of abnormal tracer uptake in the facet joint and the joint percutaneously treated.…”