Impact of single photon emission computed tomography/computed tomography bone scintigraphy on the clinical management of patients with recurrent pain post spinal fusion

OBJECTIVE: Persistent or recurrent pain following spinal fusion surgery presents a significant diagnostic and therapeutic challenge. This study aims to assess the clinical utility of single photon emission computed tomography/computed tomography (SPECT/CT) bone scintigraphy in identifying pain generators and guiding management decisions in patients with pain occurring or persisting following spinal fusion surgery. MATERIALS AND METHODS: We conducted a retrospective analysis of patients who underwent a SPECT/CT 6-24 months after cervical or lumbar spinal fusion. The impact of SPECT/CT findings on clinical decision-making was evaluated based on postoperative records. We also examined a subset of nonunion cases receiving multiple SPECT/CTs over time to assess changes in bone remodeling patterns at the fusion site. RESULTS: A total of 114 SPECT/CT scans (94 lumbar and 20 cervical) were reviewed in 106 patients and revealed pseudarthrosis with or without screw loosening (51%), adjacent level degeneration of facet joint or endplates (19%), screw irritation (12%), and extraspinal pain sources (5%). Positive SPECT/CT reports had an impact on the subsequent clinical management in 69% of cases. In 36 patients with nonunion and serial SPECT/CT scans over time, 94% showed unchanged bone remodeling patterns over time. CONCLUSION: SPECT/CT bone scintigraphy significantly contributed to clinical decision-making in the majority of patients with pain following spinal fusion. It effectively identified pain generators thereby guiding appropriate treatments. Furthermore, the imaging modality demonstrated a high degree of consistency in bone remodeling patterns over time. Our findings underscore the valuable role of SPECT/CT as a diagnostic adjunct in complex cases of failed back surgery syndrome.