What Is the Impact of Single-Photon Emission Computed Tomography on the Management of Degenerative Cervical and Lumbar Spine Disease? A Single-Institution Study

<sec><title>Background</title> SPECT-CT highlights metabolic activity within skeletal structures, including degenerative arthropathies and other potentially pain-producing abnormalities. </sec><sec><title>Objectives</title> Investigate the effectiveness of single-photon emission computed tomography (SPECT-CT) in identifying pain generators and assess its role in clinical and surgical decision-making and planning. </sec><sec><title>Methods</title> Prospective study of 110 patients presenting with neck and back pain. SPECT-CT was ordered to identify pain generators and/or guide surgical planning. Pre– and post–SPECT-CT surveys were obtained to assess pain generator identification and subsequent changes to treatment recommendations. </sec><sec><title>Results</title> SPECT-CT demonstrated increased uptake in areas corresponding to clinical symptoms in 78.1% of patients. This increased diagnostic specificity reduced the number of diagnostic possibilities per patient and led to a changed diagnosis in 68.1% of patients and a changed treatment plan in 62.7%. The nonoperative group was more likely to have specific, identified targets for injections after SPECT-CT. In 57.7% of surgical candidates, the surgical plan was altered, with 11 patients (42.3%) receiving surgical treatment recommendations involving fewer surgical levels and 4 (15.3%) involving more surgical levels. </sec><sec><title>Conclusions</title> SPECT-CT appears to be a valuable diagnostic tool in assessing neck and back pain. It may help identify pain generators and limit the need for further diagnostic workup. It was impactful in guiding treatment strategies and potentially improved surgical planning by specifically targeting the affected areas. Further research is needed to validate these findings and establish clinical guidelines for their use in patients with neck and back pain. </sec><sec><title>Level of Evidence</title> 4. </sec>