SPECT/CT imaging for diagnosis and management of failed cervical spine surgery syndrome

Abstract

Objectives: To investigate the use of SPECT/CT imaging in patients who had postoperative neck pain after cervical fusion procedures and to devise an appropriate treatment strategy for this patient population. Methods: 23 patients (8 male, 15 female) with postoperative neck pain were included in this study. Average age of patient was 60 ± 2.11 years. All patients underwent prior cervical fusion surgery and after at least 1 year of postoperative observation continue to suffer unremitting and debilitating neck pain with or without non-dermatomal arm pain. All patients underwent postoperative imaging studies including MRI and CT scan. If no clear origin of pain was detected, SPECT/CT imaging was obtained. Average number of years from prior surgery to SPECT/CT scanning was 5.5 ± 1.1 years. Preoperative VAS score averaged 8.39 ± 0.29 for this patient cohort. Results: Of the 23 patients who underwent SPECT/CT due to inadequacy of diagnosis based on anatomic studies, 15 patients underwent cervical spine surgery. Eight patients were referred to pain management based on SPECT/CT imaging and clinical symptomatology. 6 surgeries were anterior and 9 were posterior. Last follow-up evaluation after revision surgery was at 12 months. Average VAS scores declined after revision surgery to 4.74 ± 0.5. Conclusion: Identification of postoperative spinal surgery pain is necessary to design the appropriate intervention. Patients seen in our practice suffering from failed cervical spinal surgery syndrome and offered SPECT/CT imaging leading to the identification of a focus of surgical treatment experienced significant reduction in VAS scores after revision surgery.

Keywords

• Neck pain
• Failed spinal surgery syndrome
• Tc-99 SPECT/CT scan