Enhancing Low Back Pain Management: The Diagnostic and Prognostic Role of Single Photon Emission Computed Tomography-Computerized Tomography (SPECT-CT) in Surgical Outcomes.

Abstract

PURPOSE: How specific active areas on Single Photon Emission Computed Tomography-Computerized Tomography (SPECT-CT) inform management for chronic low back pain (CLBP) is limited. This study aimed to assess the relationship between SPECT-CT uptake locations with spinopelvic parameters, Pfirmann grades, and Modic changes, and to evaluate whether these locations correlate with pain outcomes after surgery. METHODS: A retrospective analysis of 26 patients who underwent SPECT-CT followed by interbody fusion from January 2018 to January 2023 was conducted. Patients were categorized based on uptake patterns in the lumbar spine: disc space only, facet joint only, or both. Key outcomes included Visual Analog Scale (VAS) pain scores at one, three, six, and 12-month intervals. Statistical analyses were performed to assess correlations and pain score changes over time. RESULTS: Of 26 patients, 38.5% exhibited uptake in the disc space, 23.0% in the facet joint, and 38.5% in both. Significant pain reductions were noted in those with disc space uptake (p = 0.016), achieving minimal clinically important difference (MCID) thresholds by six months. In contrast, facet joint uptake showed no clinically significant pain relief until 12 months, while simultaneous uptake in both areas resulted in statistically significant improvements at one, three, and 12 months (p = 0.005, 0.001, 0.032, respectively). CONCLUSION: SPECT-CT uptake in the disc space is associated with improved postoperative outcomes in CLBP, while isolated facet joint uptake does not yield significant pain relief. This study highlights the diagnostic and prognostic value of SPECT-CT in guiding surgical decision-making and improving patient outcomes.