Primary pain generator identification by CT-SPECT in a patient with low back pain: a case report.
BACKGROUND
Chronic low back pain is one of the most common conditions encountered in the middle-age population. Identifying the primary pain generator is notoriously difficult. The computed tomography-single-photon emission computed tomography (CT-SPECT) is emerging as a new diagnostic modality for this purpose.


METHODS
This 68-year-old Caucasian male presented with intractable low back pain refractory to maximal conservative treatment, including medication and extensive physical therapy. The lumbar computed tomography, magnetic resonance imaging, and flexion-extension X-rays showed advanced degenerative changes throughout the lumbar spine, but no single level significantly worse than the others. The CT-SPECT showed markedly increased uptake at the L1-2 disc level and only minimal uptake at the other levels. The patient underwent a minimally invasive lateral L1-2 fusion with near-complete resolution of his low back pain.


CONCLUSIONS
The CT-SPECT may provide a unique tool in establishing the primary pain generator in patients with degenerative spine disease.
Department of Neurosurgery, Louisiana State University, 2020 Gravier Street, Suite 744, New Orleans, LA, USA. gtende@lsuhsc.edu.
Gabriel
G
Tender
Department of Oncology, University of Craiova, Str. Alexandru Ioan Cuza, 200585, Craiova, Romania.
Adriana
A
Constantinescu
Department of Neurosurgery, Louisiana State University, 2020 Gravier Street, Suite 744, New Orleans, LA, USA.
Andrew
A
Conger
Department of Neurosurgery, Louisiana State University, 2020 Gravier Street, Suite 744, New Orleans, LA, USA.
Anthony
A
DiGiorgio
D000368:Aged; D006801:Humans; D017116:Low Back Pain / Q000000981:diagnostic imaging* / Q000601:surgery; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging* / Q000601:surgery; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D000072098:Single Photon Emission Computed Tomography Computed Tomography / Q000379:methods*; D013123:Spinal Fusion / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
CT–SPECT; Degenerative spine; Low back pain; Primary pain generator