Role of single photon emission computed tomography (SPECT/CT) in cervical spine surgery decision making

Identifying pain generators for cervical spine patients can be challenging, particularly in those with prior surgery. Single-photon emission computed tomography (SPECT/CT) may help localize potential areas of pain generation through increased radionuclide uptake. We conducted a single-institution retrospective cohort study evaluating the concordance between MRI and SPECT/CT findings and assessing outcomes after surgery targeting spinal levels with increased uptake. Demographic, clinical, and imaging data were extracted. Degenerative changes (spondylosis, facet arthropathy, stenosis, disc disease) seen on MRI were compared with SPECT/CT to determine concordance. Primary outcomes included change in neck disability index (NDI) and visual analog scale (VAS) pain scores. A 30% reduction in NDI from baseline defined the minimal clinically important difference (MCID). Fifty-three patients with both SPECT/CT and MRI were identified. Increased radionuclide uptake was seen in 50 (94%) patients; 40 (75.5%) had concordant degenerative findings on MRI. Twenty-nine (54.7%) had prior cervical instrumentation, of whom 16 (55%) had uptake at the instrumented level, and 12 (41%) had uptake at adjacent levels. Twenty patients underwent surgery targeting SPECT-positive levels. All patients demonstrated significant improvements in NDI (mean 36.2%, p < 0.001) and VAS (p < 0.001). SPECT/CT may serve as a valuable adjunct to MRI in evaluating cervical spine pathology, particularly in complex or postoperative cases. Patients who underwent surgery directed by SPECT/CT findings experienced meaningful clinical improvements. Further prospective studies are needed to validate its utility and cost-effectiveness.