A creative approach to the diagnosis and treatment of low back pain: case report and review of the literature

Chronic low back pain is a common complaint seen in the neurosurgical clinic that is often difficult to manage. A relatively new addition to the diagnostic armamentarium is single photon emission computed tomography-computed tomography (SPECT-CT). We present the case of a 76-year-old male who presented with long-standing right-sided low back pain that had progressed to the point of making him wheelchair-bound. SPECT-CT demonstrated increased uptake within an osteoblastic-appearing focus between the right L5 transverse process, sacral ala, and anterior sacroiliac joint. The patient underwent right SI joint fusion with pedicle screw fixation at L4 and L5, connected to a right-sided iliac screw. The patient had significant resolution of his pain and was able to ambulate postoperatively for the first time in several years. This creative treatment approach aimed to specifically target the problematic lesion and successfully provided clinical relief.