Utility of 18F sodium fluoride PET/CT imaging in the evaluation of postoperative pain following surgical spine fusion.
METHODS
A retrospective case review of patients who underwent 18F sodium fluoride PET/CT imaging of the spine with postoperative pain following vertebral fusion.


OBJECTIVE
To determine the benefit of 18F sodium fluoride PET/CT imaging in the diagnosis of persistent pain in the postoperative spine. The diagnosis of pain generators in the postoperative spine has proven to be a diagnostic challenge. The conventional radiologic evaluation of persistent pain after spine surgery with the use of plain radiographs, MRI, and CT can often fall short of diagnosis in the complex patient. 18F sodium fluoride PET/CT imaging is an alternative tool to accurately identify a patient's source of pain in the difficult patient.


METHODS
This retrospective study looked at 25 adult patients who had undergone 18F sodium fluoride PET/CT imaging. All patients had persistent or recurrent back pain over the course of a 15-month period after having undergone spinal fusion surgery. All patients had inconclusive dedicated MRI. The clinical accuracy of PET/CT in identifying the pain generator and contribution to altering the decision making process was compared to the use of CT scan alone.


RESULTS
Of the 25 patients studied, 17 patients had increased uptake on the 18F sodium fluoride PET/CT fusion images. There was a high-level correlation of radiotracer uptake to the patients' pain generator. Overall 88% of the studies were considered beneficial with either PET/CT altering the clinical diagnosis and treatment plan of the patient or confirming unnecessary surgery.


CONCLUSIONS
18F sodium fluoride PET/CT proves to be a useful tool in the diagnosis of complex spine pathology of the postoperative patients. In varied cases, a high correlation of metabolic activity to the source of the patient's pain was observed.
Albany Medical College, 255 Patroon Creek Blvd, Apt #1312, Albany, NY, 12206, USA. pouldad@mail.amc.edu.
D
D
Pouldar
Tower Orthopedics, Los Angeles, CA, USA.
S
S
Bakshian
Department of Radiology, Stony Brook University Medical Center, Stony Brook, NY, USA.
R
R
Matthews
Radnet, Inc., Los Angeles, CA, USA.
V
V
Rao
Department of Radiology, Loma Linda University Medical Center, Loma Linda, CA, USA.
M
M
Manzano
Radnet, Inc., Los Angeles, CA, USA.
S
S
Dardashti
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005462:Fluorine Radioisotopes; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods*; D010149:Postoperative Pain / Q000000981:diagnostic imaging*; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012969:Sodium Fluoride; D013123:Spinal Fusion
D005462:Fluorine Radioisotopes; D019275:Radiopharmaceuticals; D012969:Sodium Fluoride; C000615276:Fluorine-18
Diagnostics; PET/CT; Pain; Postoperative; Pseudarthrosis; Radiotracer; Spine; Uptake