Effect of inclusion of bone scan with SPECT/CT in the workup of low back pain patients prior to interventional procedure

91 Objectives To evaluate the role of bone scan with SPECT/CT in management of patients of low back pain prior to interventional procedure. Methods This is a randomised double blinded controlled trial . In this study 80 consecutive adults aged 20-80 years , were randomised into bone scan and control groups . Based on the clinical features and radiological findings a clinical diagnosis was made. In the bone scan group based on the finding of the bone scan and SPECT/CT a new working diagnosis was made and intervention was performed according to the working diagnosis. Controlled comparative diagnostic blocks . At the time of discharge of patient the pain relief was recorded in percentage based on the difference between the initial pain score and the pain score after placement of diagnostic blocks. Results In both the groups, sacroilitis was the commonest diagnosis followed by L4-5 facet joint and the L5-S1 facet joints. The number of patients obtaining pain relief of more than 50% was significantly higher in the bone scan group as compared to the control group. In the bone scan group 28 patients obtained good pain relief in the range of 70-100% as compared to 10 in the control group . In the bone scan group there was change in clinical diagnosis in 23 patients out of 40 patients. Three new clinical pain conditions were identified in the bone scan group. These conditions were multiple myeloma, avascular necrosis femur head and ankylosing spondylitis. Conclusions Bone scan and SPECT/CT was found to complement the clinical examination and conventional radiological imaging in workup of patients of LBP. Inclusion of SPECT /CT in bone scan in low back pain management protocol can help reduce the number of diagnostic blocks needed to identify the etiology of the LBP and at the same time bring out some new information that may be vital for the proper management of patients with low back ache.