Nuclear Medicine Imaging for Spinal Pain in the Pre- and Postoperative Setting

Area of Science:

• Nuclear Medicine
• Radiology
• Spine Surgery

Background:

• Spinal pain poses a significant clinical and socioeconomic challenge.
• Conventional imaging often fails to identify the exact pain source or differentiate active disease from incidental findings.
• Hybrid nuclear medicine imaging offers functional and metabolic insights to improve diagnostic accuracy.

Purpose of the Study:

• To review the current applications of hybrid imaging in common spinal pathologies.
• To cover both preoperative and postoperative settings for spinal pain management.
• To highlight the utility of specific hybrid techniques for different spinal conditions.

Main Methods:

• Review of current literature on hybrid nuclear medicine imaging in spinal pathologies.
• Focus on bone single photon emission computed tomography/computed tomography (SPECT/CT) and fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT).
• Analysis of applications in preoperative and postoperative spinal evaluations.

Main Results:

• Bone SPECT/CT effectively localizes degenerative changes (facet joint, disk pathology) preoperatively.
• Postoperatively, bone SPECT/CT shows high sensitivity for hardware complications, pseudoarthrosis, and adjacent segment degeneration.
• FDG-PET/CT is primarily used for detecting spinal infections.

Conclusions:

• Hybrid imaging techniques significantly enhance diagnostic capabilities for spinal pain.
• Understanding indications, timing, and interpretation is crucial for effective integration into patient management.
• These advanced imaging modalities guide targeted therapies for persistent or recurrent spinal pain.