SPECT/CT and PET/CT for the Evaluation of Persistent or Recurrent Pain After Spine Surgery: A Systematic Review and Case Series.

OBJECTIVE: The differential diagnosis for postoperative back pain is broad, and conventional imaging modalities are not always conclusive. Therefore, we performed a systematic review of the literature and present case studies describing the use of single-photon emission CT (SPECT)/CT or positron emission tomography (PET)/CT in the diagnosis of back pain following spine surgery. METHODS: A systematic review was conducted according to PRISMA guidelines across 5 databases. Relevant keywords included PET/CT, bone SPECT/CT, and pseudarthrosis. The studies were assessed for diagnostic accuracy of the imaging technologies. RESULTS: A total of 2,444 studies were screened, 91 were selected for full-text review, and 21 were ultimately included. Six retrospective studies investigated the use of SPECT/CT with a total sample size of 309 patients. Two of these studies used SPECT/CT to predict screw loosening in over 50% of patients. Eight studies examined the use of 18-fluoride sodium fluoride (18F-NaF) PET/CT. Among these studies, measures of diagnostic accuracy varied but overall demonstrated the ability of 18F-NaF PET/CT to detect screw loosening and pseudarthrosis. Seven studies examined 18F-fluorodeoxyglucose (FDG) PET/CT and supported its utility in the diagnosis of postoperative infections in the spine. CONCLUSIONS: PET/CT and SPECT/CT are useful in the evaluation of postoperative pain of the spine, especially in patients for whom conventional imaging modalities yield inconclusive results. More diagnostic accuracy studies with strong reference standards are needed to compare hybrid imaging to conventional imaging.

Pyogenic Spondylodiscitis Following Nonspinal Cesarean Section.

Pyogenic spondylodiscitis is an uncommon bacterial infection of the intervertebral disc and the vertebral endplates. It usually affects elderly patients with comorbidities but may be also seen after surgical procedures in young patients, mostly after spinal interventions and genitourinary procedures. This article describes a rare case of pyogenic spondylodiscitis in a young female patient after a cesarean section without spinal anesthesia. The patient presented with a three-month history of lower back pain, and the inflammatory markers were elevated. The magnetic resonance imaging showed the involvement of the L5-S1 disc space and the adjacent vertebral bodies. The diagnosis was confirmed with needle aspiration of purulent material. The patient was treated with antibiotics for a total of six weeks. After a follow-up of about one year, the patient showed slight degenerative vertebral changes with no signs of residual infection. This case highlights the importance of the early recognition of pyogenic spondylodiscitis as one cause of postoperative back pain after urogenital procedures, even without spinal anesthesia. Only a few similar cases were reported in the literature.

Do preoperative clinical and radiographic characteristics impact patient outcomes following one-level minimally invasive transforaminal lumbar interbody fusion based upon presenting symptoms?

BACKGROUND CONTEXT: Patients undergoing minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) frequently present with lower extremity neurologic symptoms with or without associated lower back pain. While symptomatic improvement of leg and back pain has been reported, the resolution of back pain when it is a predominant presenting symptom remains underreported following MI-TLIF. PURPOSE: The purpose of this study was to compare clinical outcomes at 1 year of patients undergoing MI-TLIF with lower extremity neurologic symptoms with and without a significant component of back pain. STUDY DESIGN: A retrospective review of prospectively collected data from a single surgeon surgical database from 2017 to 2019 was performed. PATIENT SAMPLE: Fifty one patients undergoing MI-TLIF. OUTCOME MEASURES: Self-reported measures included the Oswestry Disability Index (ODI), Visual analog scale back pain (VAS-back), and VAS leg pain (VAS-leg). METHODS: Patients were divided into two groups: Leg Pain Predominant (patients reported greater than 50% leg pain upon presentation) and Back Pain Predominant (patients reported 50% or greater back pain). Multivariate analysis was performed to determine differences between groups based upon any significantly baseline characteristics. RESULTS: Preoperative demographic and radiographic outcomes were similar between the two groups. Both groups demonstrated significant improvement in ODI, VAS-Back and VAS-leg at 1-year postoperatively. On multivariate analysis, there were differences in ODI at 1-year, 1-year back pain, and 1-year leg pain between groups with those who initially presented with leg pain having a lower ODI, VAS Back, and VAS leg. Patients who presented with predominantly leg pain were more likely to meet minimal clinically important difference (MCID) criteria for ODI and VAS-back compared to those with predominantly back pain. CONCLUSION: Following MI-TLIF, patients with lower extremity neurologic symptoms with and without a significant component of back pain have improvements in back pain, leg pain, and ODI regardless of their primary presenting pain complaint; however, patients who presented with predominantly leg pain were more likely to meet MCID criteria for improvement in their back pain and ODI score.

Changes of Muscle Related Enzymes after Posterior Approaches to the Lumbar Spine

OBJECTIVE: Creatine phosphokinase-MM(CPK-MM) and lactate dehydrogenase(LDH) are well known indices of muscular injury. To know the degree of muscular injury during spinal surgery, the author report serial measurement of serum CPK-MM and LDH4 level. METHODS: The authors investigated 23 patients who underwent lumbar spinal surgery without bone fusion or instrumentation. Peripheral venous blood samples were serially collected 1 day before surgery, operation day, postoperative 3rd, 7th, 14th and 28th day. Postoperative back pain was measured by visual analogue scale. We evaluated the relationship between number of operation level, serial changes of serum CPK-MM, LDH4, duration of surgery and postoperative back pain. RESULTS: CPK-MM activity was higher after surgery than before it and reached at maximal level on the postoperative 3rd day, and it was returned to normal level on the postoperative 7th day. The score of postoperative back pain scale was the highest on the postoperative 3rd day. CPK-MM activity was significantly correlated with operation level, duration of surgery, and postoperative back pain(P0.05). CONCLUSION: Postoperative muscle injury is inevitable in all patient who underwent spinal surgery, and these injuries are related extent of exposure and duration of surgery. To reduce muscle injury and postoperative back pain, less invasive and shorter surgery in time is recommend.

The Effect of Diclofenac Sodium on Uncontrolled Postoperative Back Pain by IV-PCA / 대한마취과학회지

BACKGROUND: Although postoperative back pain has been reported to occur, as a frequent complication of anesthesia and surgery, it is usually mild and self-limited. However, we experienced cases of uncontrolled postoperative back pain in patients even after IV-PCA administration. These patients' back pain was relieved by the traditional diclofenac sodium intramuscular injection, so we evaluated the efficacy of diclofenac sodium on uncontrolled postoperative back pain by IV-PCA. METHODS: We studied 16 patients who complained of postoperative back pain even with IV-PCA for postoperative pain control. When NRS pain score was above 5, the patients were treated with a diclofenac sodium 75 mg intramuscular injection. Postoperative back pain and operation site pain was measured by NRS before and after diclofenac sodium injection. RESULTS: There was a significant decrease in the pain score of postoperative back pain after diclofenac sodium injection without a dramatic improvement of operation site pain. CONCLUSIONS: Diclofenac sodium plays a useful role in the control of acute postoperative back pain.