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Primary pain generator identification by CT-SPECT in a patient with low back pain: a case report
Gabriel Tender1, Adriana Constantinescu2, Andrew Conger3
1Department of Neurosurgery, Louisiana State University, 2020 Gravier Street, Suite 744, New Orleans, LA, USA. gtende@lsuhsc.edu.
Background:
Chronic low back pain is one of the most common conditions encountered in the middle-age population. Identifying the primary pain generator is notoriously difficult. The computed tomography-single-photon emission computed tomography (CT-SPECT) is emerging as a new diagnostic modality for this purpose.
Case Presentation:
This 68-year-old Caucasian male presented with intractable low back pain refractory to maximal conservative treatment, including medication and extensive physical therapy. The lumbar computed tomography, magnetic resonance imaging, and flexion-extension X-rays showed advanced degenerative changes throughout the lumbar spine, but no single level significantly worse than the others. The CT-SPECT showed markedly increased uptake at the L1-2 disc level and only minimal uptake at the other levels. The patient underwent a minimally invasive lateral L1-2 fusion with near-complete resolution of his low back pain.
Conclusions:
The CT-SPECT may provide a unique tool in establishing the primary pain generator in patients with degenerative spine disease.
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