TY - JOUR
T1 - SPECT-CT as a Predictor of Pain Generators in Patients Undergoing Intra-Articular Injections for Chronic Neck and Back Pain
AU - Garcia, Diogo
AU - Sousa-Pinto, Bernardo
AU - Akinduro, Oluwaseun O.
AU - De Biase, Gaetano
AU - Filho, Leonardo Macedo
AU - Qu, Wenchun
AU - Atchison, James W.
AU - Deen, H. Gordon
AU - Nottmeier, Eric
AU - Chen, Selby
AU - Bydon, Mohamad
AU - Sandhu, Sukhwinder S.
AU - Scholten, Paul
AU - Quinones-Hinojosa, Alfredo
AU - Abode-Iyamah, Kingsley
N1 - Funding Information:
Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher Copyright:
© 2022 Elsevier Inc.
PY - 2022/8
Y1 - 2022/8
N2 - Background: The ability to accurately predict pain generators for chronic neck and back pain remains elusive. Objective: We evaluated whether injections targeted at foci with uptake on single-photon emission computerized tomography–computed tomography (SPECT-CT) were associated with improved outcomes in patients with chronic neck and back pain. Methods: A retrospective review was completed on patients undergoing SPECT-CT for chronic neck and back pain between 2016 and 2020 at a tertiary academic center. Patients' records were reviewed for demographic, clinical, imaging, and outcomes data. Only those patients who had facet injections after SPECT-CT were included in this evaluation. Patients undergoing injections targeted at foci of abnormal radiotracer uptake were compared with patients without uptake concerning immediate positive response, visual analog scale, and the need for additional injection or surgery at the target level. Results: A total of 2849 patients were evaluated with a SPECT-CT for chronic neck and back pain. Of those, 340 (11.9%) patients received facet joint injections after SPECT-CT. A propensity score regression analysis adjusted for age, gender, body mass index, hypertension, multiple target injections, and injection location showed uptake targeted injections not being associated with an improved immediate positive response (odds ratio: 0.64; 95% confidence interval: 0.34–1.21; P = 0.172). In patients with a failed facet injection preceding SPECT-CT, adding SPECT-CT to guide facet injections was associated with a decrease in visual analog scale pain scores 2 weeks after injection (P = 0.018), particularly when changes were made to the facets being targeted (P = 0.010). Conclusion: This study suggests that there is benefit with SPECT-CT specially to guide facet injections after failed prior facet injections.
AB - Background: The ability to accurately predict pain generators for chronic neck and back pain remains elusive. Objective: We evaluated whether injections targeted at foci with uptake on single-photon emission computerized tomography–computed tomography (SPECT-CT) were associated with improved outcomes in patients with chronic neck and back pain. Methods: A retrospective review was completed on patients undergoing SPECT-CT for chronic neck and back pain between 2016 and 2020 at a tertiary academic center. Patients' records were reviewed for demographic, clinical, imaging, and outcomes data. Only those patients who had facet injections after SPECT-CT were included in this evaluation. Patients undergoing injections targeted at foci of abnormal radiotracer uptake were compared with patients without uptake concerning immediate positive response, visual analog scale, and the need for additional injection or surgery at the target level. Results: A total of 2849 patients were evaluated with a SPECT-CT for chronic neck and back pain. Of those, 340 (11.9%) patients received facet joint injections after SPECT-CT. A propensity score regression analysis adjusted for age, gender, body mass index, hypertension, multiple target injections, and injection location showed uptake targeted injections not being associated with an improved immediate positive response (odds ratio: 0.64; 95% confidence interval: 0.34–1.21; P = 0.172). In patients with a failed facet injection preceding SPECT-CT, adding SPECT-CT to guide facet injections was associated with a decrease in visual analog scale pain scores 2 weeks after injection (P = 0.018), particularly when changes were made to the facets being targeted (P = 0.010). Conclusion: This study suggests that there is benefit with SPECT-CT specially to guide facet injections after failed prior facet injections.
KW - Minimally invasive
KW - Spinal
KW - Spine surgery
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U2 - 10.1016/j.wneu.2022.06.013
DO - 10.1016/j.wneu.2022.06.013
M3 - Article
C2 - 35691522
AN - SCOPUS:85133379347
SN - 1878-8750
VL - 164
SP - e1243-e1250
JO - World neurosurgery
JF - World neurosurgery
ER -