Sophisticated Imaging Helps With Back Surgery Pain
People with recurrent back pain after spine surgery have new hope for relief thanks in part to sophisticated imaging at Beaumont Hospitals that lets doctors "see" inside the body more clearly.
The imaging combines low-dose CT scans of the problem area (instead of the entire spine, in an effort to minimize the radiation dose) with 3-D SPECT - single-photon emission computed tomography - bone images along with computer software that fuses the resulting images together to get rid of distortions. This helps to create a 3-D picture of what is happening within the bones in the spine and any hardware the spine surgeon may have used to stabilize them.
The hardware can include metal bone screws, rods and plates. While the hardware is used to help stabilize the spine, an unhappy consequence is that it also causes the distortions on conventional imaging such as X-rays, CT scans and MRI, which can be used to help pinpoint the source of the postoperative pain.
"Everything becomes clear," says spine surgeon Richard Easton, M.D., an orthopedic surgery specialist. "We're able to finally see around the hardware as to what's happening with the bone."
SPECT-CT helps Dr. Easton evaluate a bone graft that may not have healed or hardware that has become loose, for example.
People who previously thought they had to live with their pain are being helped as a result, sometimes with minimally invasive surgery that lets them get back to their normal lives sooner.
"These people had been thrown out by the system," says Dr. Easton. "We take those patients off the discard pile and put them back into society."
The imaging also can tell doctors if the pain is coming from the prior surgery or from another source, helping to tailor the best treatment plan. It can tell them when surgery won't help, helping to avoid unnecessary operations and enabling the people with back pain to seek other treatment as soon as possible.
Combining SPECT with CT imaging provides exquisite detail and precise anatomical information to get the most accurate image possible.
"The artifacts (distortions) on the SPECT scan don't affect the findings on the CT scan since the images are acquired separately," says nuclear medicine specialist Paresh Mahajan, M.D., who supervises the use of SPECT-CT at Beaumont Hospital, Royal Oak. "That's where the synergy comes in, giving the most accurate information that leads to improved patient care."
Despite the sophistication of SPECT-CT, the additional radiation dose from the CT scan is minimal and may even be used in women who may become pregnant and children.