title: The Usefulness of Single-Photon Emission Computed Tomography in Defining Painful Upper Cervical Facet Arthropathy.
abstract: OBJECTIVE
  Standard imaging techniques have low predictive value for identifying sources of neck pain. Single-photon emission computed tomography (SPECT) imaging in conjunction with computed tomography (CT) provides the sensitivity of bone scanning for areas of high metabolic activity with the sensitivity of CT for anatomic localization. We evaluated the usefulness of SPECT-CT imaging in identifying pain generators in upper cervical facet arthropathy.
  
  
  METHODS
  In a retrospective study, we reviewed 7 patients (mean age, 68.7 years) who underwent diagnostic SPECT-CT imaging for upper cervical neck pain at our institution from August 2011 to February 2015. We assessed SPECT-CT radiotracer uptake and postoperative neck disability index (NDI) and visual analog scale (VAS) scores.
  
  
  RESULTS
  Mean preoperative NDI and VAS scores were 42% (range, 34%-72%) and 7/10 (range, 5-8), respectively. SPECT-CT showed increased radiotracer uptake and inflammation at the level of pain generation indicated by history and physical examination. Intraoperatively, all patients had corresponding facet hypertrophy with degeneration at the site of increased radiotracer uptake. The mean postoperative NDI and VAS scores at 9 months were 23% (0%-54%) and 2/10 (0-5), respectively, representing improvements of 20% (P = 0.025) and 4 (P = 0.0028), respectively.
  
  
  CONCLUSIONS
  SPECT-CT imaging of the upper cervical spine is a potentially sensitive diagnostic test that can implicate pain generators with increased metabolic activity. We propose that SPECT-CT may be a useful adjunct in the workup for neck pain secondary to facet arthropathy that could obviate diagnostic injections.
authors.affiliation: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Vijay M
authors.initials: VM
authors.lastname: Ravindra
authors.affiliation: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Marcus D
authors.initials: MD
authors.lastname: Mazur
authors.affiliation: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Erica F
authors.initials: EF
authors.lastname: Bisson
authors.affiliation: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Craig
authors.initials: C
authors.lastname: Barton
authors.affiliation: Division of Neuroradiology, Department of Radiology, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Lubdha M
authors.initials: LM
authors.lastname: Shah
authors.affiliation: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA. Electronic address: neuropub@hsc.utah.edu.
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Dailey
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007592:Joint Diseases / Q000150:complications* / Q000000981:diagnostic imaging*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000000981:diagnostic imaging / Q000209:etiology*; D012189:Retrospective Studies; D015899:Tomography, Emission-Computed, Single-Photon; D021801:Zygapophyseal Joint / Q000000981:diagnostic imaging*
keywords: (99m)TcMDP (technetium 99m methylene diphosphonate); Facet arthropathy; Neck disability index; Neck pain; SPECT-CT; Single-photon emission computed tomography