SPECT of the cervical spine in the evaluation of neck pain after trauma

In a retrospective study, the authors reviewed the use of SPECT in the evaluation of cervical spine abnormalities in 35 patients with persistent neck pain after trauma. Nineteen patients had normal bone SPECT studies, which, in addition to several volunteers, were used to identify tomographic landmarks and determine resolution of individual vertebrae. Sixteen patients had abnormal SPECT results. When compared to final diagnosis, this group included seven (44%) patients with recent fractures, five (31%) patients with traumatic periostitis (periosteal injury resulting from severe strain), and four patients (25%) with mild cervical strain superimposed on degenerative changes. SPECT sensitivity in the detection of recent fractures was 100% with a specificity of 78%. SPECT detected occult fractures in 7 of 35 patients (27%), including 3 patients with normal radiographs and 4 patients with equivocal radiographs. Recent fractures were excluded in six of nine patients (67%) with known fracture identified on cervical spine radiographs and none of the patients with normal SPECTs had CT or MRI evidence of recent fractures. SPECT was useful in 1) the diagnosis of occult fractures or periostitis (periosteal injury) in patients with normal radiographs, 2) characterization of radiographic abnormalities (recent versus healed fractures), 3) identification of active, possible post-traumatic osteoarthritis superimposed on chronic degenerative disease, and 4) eliminating or targeting subsequent imaging modalities, when appropriate. The authors conclude that bone SPECT has a valuable place in the diagnostic evaluation of patients with persistent neck pain after trauma.