Nuclear scintigraphic assessment of the thoracolumbar synovial intervertebral articulations

The results of nuclear scintigraphic examination of the thoracolumbar synovial intervertebral articulations (facet joints) have to date been poorly documented.

To establish an objective scintigraphic grading system for the facet joints; to investigate the relationship between the presence or absence of clinical signs of back pain and increased radiopharmaceutical uptake (IRU); and to compare the results of scintigraphy and radiography.

Nuclear scintigraphic images of the 13th thoracic (T13) to first lumbar (L1) vertebrae were graded subjectively (visual assessment of the image) and objectively (using region of interest analysis) from 31 clinically normal horses in full work (Group N) and 65 horses with clinical evidence of thoracolumbar region pain and osteoarthritis of > or = 1 facet joint (Group B). Sensitivity and specificity of IRU for detection of back pain and radiographic abnormalities were assessed. A Spearman correlation was performed to test for an association between the grade of IRU and the classification of radiographic abnormality.

The objective scintigraphic grades were matched by 96.7% of subjective grades. IRU was seen more commonly in Group B (61.5%) than in Group N (25.8%), and moderate or intense IRU was only seen in Group B. The strongest association between radiographic abnormalities and scintigraphy was seen in horses with intense IRU.

Moderate or intense IRU in a facet joint is more likely to be seen in horses with back pain than in clinically normal horses.

Nuclear scintigraphy is a potentially useful tool in the evaluation of a horse with thoracolumbar region pain.