SPECT/CT in the Assessment of Postoperative Spine: A Comprehensive Literature Review

Back pain is a widespread and debilitating condition that significantly impairs quality of life, often eroding patients' sense of autonomy and independence, and contributes to global disability rates. The initial management of back pain generally follows a conservative approach, encompassing physical therapy, pharmacological interventions, and lifestyle modifications aimed at alleviating symptoms and restoring functionality. Spine surgery, while frequently beneficial in addressing underlying structural issues, carries certain inherent risks. Among the most challenging outcomes of spine surgery is the persistence or recurrence of pain, a condition commonly referred to as failed back surgery syndrome (FBSS). The effective management of FBSS requires a comprehensive and meticulous approach. When conservative measures for FBSS fail to yield satisfactory results, revision surgery can be considered. The role of advanced imaging techniques is critical in these cases. Standard imaging modalities each involve unique advantages and limitations, and a multimodal approach is therefore important to achieve a comprehensive and accurate evaluation of the patient's condition. In recent years, single-photon emission computed tomography combined with computed tomography (SPECT/CT) has gained recognition as a valuable tool in the postoperative assessment of spine surgery patients. SPECT/CT has demonstrated superior efficacy in detecting specific complications, such as pseudoarthrosis, hardware failure, and screw loosening. By integrating metabolic activity data from the spine and surrounding bony structures with the three-dimensional reconstruction capabilities of CT, SPECT/CT enhances diagnostic accuracy and informs more precise treatment decisions. This review aims to synthesize the current body of literature on the application of SPECT/CT in the postoperative evaluation of spine surgery patients, while also providing a comparative overview of other imaging modalities within this context. Our objective is to underscore the pivotal role that advanced imaging techniques play in improving patient outcomes after spine surgery, reducing the incidence of FBSS, and shortening its duration.