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 o utcomes) of SPECT in low back pain? 3. What is the cost-effectiveness of SPECT in low back pain? Methods: We conducted a comprehensive struc tured review of the literature, analyzing 940 citations from 1966 thro ugh September 1993 and completed a narrative review. We also attempted quantitative synthesis of the accuracy of SPECT evaluation of low bac k pain. Results: We found thirteen reports on accuracy. Only three pro vided a reasonable gold standard reference test and allowed the calcul ation of sensitivity and specificity. There is weak evidence that SPEC T is useful in: (a) detecting pseudarthroses after failed spinal fusio n, (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 d ecision to use SPECT in most patients with low back pain cannot be sup ported 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.