CLINICAL EFFICACY OF SPECT BONE IMAGING FOR LOW-BACK-PAIN

SPECT has been advocated as an accurate and useful diagnostic tool for patients with low back pain. We sought to answer three questions: 1. What is the accuracy of SPECT in diagnosing the cause of low back pain? 2. What is the clinical effect (influence on management or patient outcomes) of SPECT in low back pain? 3. What is the cost-effectiveness of SPECT in low back pain? Methods: We conducted a comprehensive structured review of the literature, analyzing 940 citations from 1966 through September 1993 and completed a narrative review. We also attempted quantitative synthesis of the accuracy of SPECT evaluation of low back pain. Results: We found thirteen reports on accuracy. Only three provided a reasonable gold standard reference test and allowed the calculation of sensitivity and specificity. There is weak evidence that SPECT is useful in: (a) detecting pseudarthroses after failed spinal fusion, (b) evaluating young patients with back pain and (c) distinguishing benign from malignant lesions in cancer patients. SPECT has not been sufficiently studied in any other setting. We found no reports on the clinical outcome of SPECT or its cost-effectiveness. Conclusion: The decision to use SPECT in most patients with low back pain cannot be supported by clinical trials. Its effect on clinical management and cost-effectiveness are unknown. The medical community should mount a large-scale, prospective evaluation of SPECT in low back pain.