The Usefulness of Single-Photon Emission Computed Tomography in Defining Painful Upper Cervical Facet Arthropathy

Standard imaging techniques have low predictive value for identifying sources of neck pain. Single-photon emission computed tomography (SPECT) imaging in conjunction with computed tomography (CT) provides the sensitivity of bone scanning for areas of high metabolic activity with the sensitivity of CT for anatomic localization. We evaluated the usefulness of SPECT-CT imaging in identifying pain generators in upper cervical facet arthropathy.

In a retrospective study, we reviewed 7 patients (mean age, 68.7 years) who underwent diagnostic SPECT-CT imaging for upper cervical neck pain at our institution from August 2011 to February 2015. We assessed SPECT-CT radiotracer uptake and postoperative neck disability index (NDI) and visual analog scale (VAS) scores.

Mean preoperative NDI and VAS scores were 42% (range, 34%-72%) and 7/10 (range, 5-8), respectively. SPECT-CT showed increased radiotracer uptake and inflammation at the level of pain generation indicated by history and physical examination. Intraoperatively, all patients had corresponding facet hypertrophy with degeneration at the site of increased radiotracer uptake. The mean postoperative NDI and VAS scores at 9 months were 23% (0%-54%) and 2/10 (0-5), respectively, representing improvements of 20% (P = 0.025) and 4 (P = 0.0028), respectively.

SPECT-CT imaging of the upper cervical spine is a potentially sensitive diagnostic test that can implicate pain generators with increased metabolic activity. We propose that SPECT-CT may be a useful adjunct in the workup for neck pain secondary to facet arthropathy that could obviate diagnostic injections.