Role of Single-Photon Emission Computed Tomography Imaging in the Diagnosis and Treatment of Chronic Neck or Back Pain Caused by Spinal Degeneration: A Systematic Review
Abstract
INTRODUCTION: Chronic neck or back pain is a common clinical problem. The most likely cause is degenerative change, whilst other causes are relatively rare.
There is growing evidence on using hybrid single-photon emission computed tomography (SPECT) scan to identify the pain generator in spine degeneration. This systematic review explores the diagnostic and therapeutic evidence on chronic neck or back pain examined by SPECT.
METHODS: This review is reported in accordance with the PRISMA guidelines. In October 2022, we searched the following sources:MEDLINE, Embase, CINAHL, SCOPUS,and three other sources.
Titles and abstracts were screened and classified into diagnostic studies,facet block studies and surgical studies. We synthesized the results narratively.
RESULTS: The search yielded a total of 2347 records. We identified ten diagnostic studies comparing SPECT or SPECT/CT to MRI, CT, scintigraphy or clinical examination.
Furthermore, we found eight studies comparing the effect of facet block intervention in SPECT-positive and SPECT-negative patients with cervicogenic headache, neck pain and lower back pain. Five surgical studies describing the effect of fusion for facet arthropathy in the craniocervical junction,subaxial cervical spine or the lumbar spine were identified.
CONCLUSION: According to available literature, a positive finding on SPECT in facet arthropathy is associated with a significantly higher facet blockade effect. Surgical treatment of positive findings has a very good effect, but this has not been confirmed by controlled studies.
SPECT/CT might be therefore a useful method in the evaluation of patients with neck or back pain, especially in cases of unclear findings or multiple degenerative changes.