Nuclear Medicine Imaging for Spinal Pain in the Pre- and Postoperative Setting

Spinal pain represents a significant clinical and socioeconomic burden, with conventional imaging often unable to identify the precise pain generator or distinguish active pathology from incidental degenerative findings. Hybrid nuclear medicine imaging techniques, such as bone single photon emission computed tomography/computed tomography and fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography, provide complementary functional and metabolic information that can enhance diagnostic accuracy in selected patients.This review summarizes current applications of hybrid imaging in prevalent spinal pathologies across preoperative and postoperative settings. In preoperative evaluation, bone single photon emission computed tomography/computed tomography localizes symptomatic degenerative changes, including facet joint and disk pathology. Postoperatively, bone single photon emission computed tomography/computed tomography demonstrates high sensitivity for hardware complications, pseudoarthrosis, and adjacent segment degeneration. In contrast, fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography is used to detect spinal infection. Understanding appropriate indications, optimal timing, and interpretive pitfalls is essential to integrate these techniques effectively into multidisciplinary management pathways and guide targeted therapeutic interventions in patients with persistent or recurrent spinal pain.