SPECT bone scan is the reference standard for detection of radiographically occult active spondylolysis in the young patient [31]. Although the utility of discography in patients with LBP remains controversial, a systematic review by Manchikanti et al [32] provides level III evidence that lumbar discography may be useful in patients with chronic discogenic LBP. Bone Scan Whole Body with SPECT or SPECT/CT Complete Spine Structures with abnormal morphology on conventional imaging may not be the cause of LBP. Limited evidence suggests possible utility of bone scan with SPECT or SPECT/CT as a functional modality to localize the source of LBP, particularly for facet arthropathy [28-30]. A prospective study of 99 patients with LBP evaluated with SPECT/CT demonstrated >40% of scintigraphically active facet joints did not correlate to degree of facet joint degeneration on CT, using standardized grading scales [29]. A randomized double-blinded controlled study of 80 patients showed >50% pain relief in patients who received diagnostic facet or sacroiliac joint anesthetic blocks based on clinical and SPECT/CT findings compared with those who received blocks based on clinical and conventional imaging findings [28]. SPECT bone scan is the reference standard for detection of radiographically occult active spondylolysis in the young patient [31]. CT Lumbar Spine With IV Contrast There is no relevant literature to support the use of CT lumbar spine with IV contrast in the evaluation of a surgery or intervention candidate with persistent or progressive symptoms during or following 6 weeks of conservative management. CT Lumbar Spine Without and With IV Contrast There is no relevant literature to support the use of CT lumbar spine without and with IV contrast in the evaluation of a surgery or intervention candidate with persistent or progressive symptoms during or following 6 weeks of conservative management.
Low Back Pain PCAs. SPECT bone scan is the reference standard for detection of radiographically occult active spondylolysis in the young patient [31]. Although the utility of discography in patients with LBP remains controversial, a systematic review by Manchikanti et al [32] provides level III evidence that lumbar discography may be useful in patients with chronic discogenic LBP. Bone Scan Whole Body with SPECT or SPECT/CT Complete Spine Structures with abnormal morphology on conventional imaging may not be the cause of LBP. Limited evidence suggests possible utility of bone scan with SPECT or SPECT/CT as a functional modality to localize the source of LBP, particularly for facet arthropathy [28-30]. A prospective study of 99 patients with LBP evaluated with SPECT/CT demonstrated >40% of scintigraphically active facet joints did not correlate to degree of facet joint degeneration on CT, using standardized grading scales [29]. A randomized double-blinded controlled study of 80 patients showed >50% pain relief in patients who received diagnostic facet or sacroiliac joint anesthetic blocks based on clinical and SPECT/CT findings compared with those who received blocks based on clinical and conventional imaging findings [28]. SPECT bone scan is the reference standard for detection of radiographically occult active spondylolysis in the young patient [31]. CT Lumbar Spine With IV Contrast There is no relevant literature to support the use of CT lumbar spine with IV contrast in the evaluation of a surgery or intervention candidate with persistent or progressive symptoms during or following 6 weeks of conservative management. CT Lumbar Spine Without and With IV Contrast There is no relevant literature to support the use of CT lumbar spine without and with IV contrast in the evaluation of a surgery or intervention candidate with persistent or progressive symptoms during or following 6 weeks of conservative management.