Orthopedic Applications of Single-photon Emission Computed Tomography/Computed Tomography in Identifying Pain Generators in the Pre- and Post-operative Patient

Postoperative and benign bone pathologies can sometimes be difficult to elicit on purely anatomical-based imaging. Single-photon emission computed tomography-computed tomography (SPECT-CT) is an established modality with emerging applications in the musculoskeletal field that combines cross-sectional structural imaging with the metabolic data. It is thought to offer certain clinical advantages to conventional imaging modalities as it can be sensitive to conditions before they appear as a structural abnormality. The aim of this pictorial review is to demonstrate the musculoskeletal applications of SPECT/CT in the pre- and post-operative orthopedic patient. The evidence for the musculoskeletal application of SPECT/CT is reviewed in various pre- and post-operative patients focusing on the advantages and disadvantages of this imaging modality alongside conventional imaging. Alongside this we present a series of musculoskeletal SPECT/CT cases in postoperative spinal and extremity joints identifying such pathologies as loosening, pseudoarthroses and prosthetic joint infection. We also include cases on the nonoperative joint identifying pain generators for targeted therapy. This review has shown that SPECT/CT can be a useful adjunct alongside other conventional imaging modalities in identifying musculoskeletal pain generators in the postoperative patient. It is especially useful in situations where anatomical imaging modalities alone provide insufficient diagnostic information or lack of symptomatic improvement. SPECT/CT is therefore likely to remain an complimentary investigative tool for unidentified musculoskeletal pain or for postoperative patients with metalwork in situ .