A molecular imaging scan in addition to a conventional bone scan can provide the necessary information about the physiological health of the spine to select the most appropriate pain-killing treatment protocol for patients suffering from low back pain, according to a study presented at the 2014 Annual Meeting of the Society of Nuclear Medicine and Molecular Imaging (SNMMI).
Conventional imaging methods including x-ray, computed tomography (CT), and even magnetic resonance imaging (MRI) show the structure of the bone, but the source of the pain is often not directly related to obvious structural changes.
Single photon emission computed tomography (SPECT) combined with CT (SPECT/CT) is able to go beyond structure to pinpoint the subtle physiological processes causing the pain, such as inflammation or infection. With more clinical certainty, interventionalists can offer a range of treatments to relieve their patients’ suffering.
“Low back pain is an extremely common problem that affects most people at some point in their life,” said Suruchi Jain, 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 aim of the study was to compare the difference in pain relief following clinical pain management between 2 groups of patients. A total of 80 adults aged 20 to 80 years were randomised to receive conventional bone scans with the addition of SPECT/CT, and a second group acted as a control, with no imaging provided prior to intervention. Patients were evaluated on a scale according to percentage of pain relief compared with their baseline level prior to treatment.
Patients with greater than 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 with only 10 patients in the control group.
Clinical diagnosis was altered for 23 out of 40 patients in the bone scan group, and 3 new conditions were unveiled as a result of the bone scan. This evidence could improve 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,” said Dr. Jain.