Striking New Paths in Treating Lower Back Pain -- MEDICA - World Forum for Medicine

About 85 per cent of adults sometimes suffer from back pain during their lives, but chronic lower back pain is often caused by degenerative changes in the spine. It is normally treated by steroid and anesthetic injections to the small joints of the spine.

Spiros G. Pneumaticos, M.D., assistant professor of orthopaedic surgery at Baylor College of Medicine in Houston/Texas and the lead author of a new study referring to this issue, explains: “Bone SPECT can help identify the patients with lower back pain who would benefit from facet joint injections. The patients with negative bone SPECT should be spared the injections.” For a bone SPECT exam, the patient receives an injection into the vein with a radioactive material. He lies underneath the camera, pictures are taken for approximately 30 minutes and afterwards, the images illuminate abnormalities in cell function.

In the study, 23 men and 34 women with low back pain and who were scheduled for facet joint injections, were examined. Group A had bone SPECT prior to injection. Group B did not. Patients showing positive SPECT results (Group A1) received injections at the levels of the lumbar spine showing abnormalities on the scan. Patients showing no facet joint abnormality on SPECT (Group A2) along with Group B patients received injections at the levels indicated by the referring physician.

A month later, Group A1 patients’ pain reduction was significantly higher than in the other two groups. Only 27 facets required injection, a sizable decrease from the referring physician recommendation of 60. This means a $326 cut of costs per patient.

Pneumaticos concludes: “Patients with a positive bone SPECT have an excellent response to facet injections, while patients with a negative SPECT have a much smaller chance of improving.”; Source: Radiological Society of North America