title: The value of SPECT scans in identifying back pain likely to benefit from facet joint injection.
abstract: Lumbar facet disease is sometimes implicated in low back pain. Identification is difficult and this may account for a variable response. Single photon emission computerized tomography (SPECT) is a scanning technique which enables localization of facet joint pathology. We determined whether recognition of facet disease by this method improved the response to corticosteroid injection treatment. Fifty-eight patients with low back pain and displaying accepted clinical criteria for facet joint disease were evaluated by SPECT. Twenty-two had facetal uptake of isotope. These and the tender facet joints of 36 scan-negative patients were injected with 40 mg methylprednisolone and 1 ml 1% lignocaine under X-ray control. Pain was assessed by a blind observer using the McGill questionnaire (MGQ), Present Pain Intensity score (PPI) and a Visual Analogue Scale (VAS). VAS, PPI and MGQ were reduced in the scan-positive patients at 1 month (P = 0.05, P = 0.0005, P = 0.005) and MGQ at 3 months (P = 0.01), whilst scan-negative patients were unchanged. The percentage of scan-positive patients who reported improvement was 95% at 1 month and 79% at 3 months, significantly greater than the control group (P = 0.0005, P = 0.01). Within 6 months, pain improvement in the SPECT-positive group was no longer statistically significant. Tenderness did not correlate with increased uptake on SPECT scan. Osteoarthritis of the facets was more common in the SPECT-positive patients (P < 0.001), but did not correspond with sites of increased uptake on SPECT scan. These results suggest that SPECT can enhance the identification of back pain sufferers likely to obtain short-term benefit from facet joint injection.
authors.affiliation: Clinical Rheumatology Unit, Guy's Hospital, London.
authors.forename: A L
authors.initials: AL
authors.lastname: Dolan
authors.forename: P J
authors.initials: PJ
authors.lastname: Ryan
authors.forename: N K
authors.initials: NK
authors.lastname: Arden
authors.forename: R
authors.initials: R
authors.lastname: Stratton
authors.forename: J R
authors.initials: JR
authors.lastname: Wedley
authors.forename: W
authors.initials: W
authors.lastname: Hamann
authors.forename: I
authors.initials: I
authors.lastname: Fogelman
authors.forename: T
authors.initials: T
authors.lastname: Gibson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D001416:Back Pain / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D008012:Lidocaine / Q000008:administration & dosage; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D008875:Middle Aged; D011237:Predictive Value of Tests; D011859:Radiography; D011877:Radionuclide Imaging; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D008012:Lidocaine; D008775:Methylprednisolone