SPECT/CT Use as an Indicator of Low-Grade Infection in the Spine: Report of Two Cases

Document Type : CASE REPORT

Authors

Orthopedic Surgery British Hospital of Buenos Aires, Buenos Aires, Argentina

Abstract

Low back pain is one of the most common pathologies worldwide. When conservative treatment fails to
yield good results, surgery is the recommended approach. Despite spinal fusion, some patients
continue to experience persistent low back pain. This is where a series of studies come into play to
detect the source of treatment failure. The use of bone scintigraphy with SPECT (single -photon
emission computed tomography) in combination with computed tomography (CT) has greatly improved
the anatomical localization of abnormalities found in SPECT. While pseudoarthrosis is a significant
cause of spinal fusion failure, in recent years, it has been observed that certain low-virulence pathogens
are also implicated in persistent low back pain. This is the focus of our s tudy, in which we identified
two patients with persistent low back pain after surgery, both of whom tested positive for chronic low -
grade infection using SPECT/CT.
 Level of evidence: IV

Keywords

Main Subjects

References

  1. Hoy D, March L, Brooks P, et al. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014;73(6):968-974. doi:10.1136/annrheumdis-2013-204428
  2. Maniadakis N, Gray A. The economic burden of back pain in the UK. Pain. 2000;84(1):95-103. doi:10.1016/S0304-3959(99)00187-6.
  3. Williams AL, Gornet MF, Burkus JK. CT evaluation of lumbar interbody fusion: current concepts. AJNR Am J Neuroradiol. 2005;26(8):2057-2066.
  4. Martin BI, Mirza SK, Comstock BA, Gray DT, Kreuter W, Deyo RA. Are lumbar spine reoperation rates falling with greater use of fusion surgery and new surgical technology?. Spine (Phila Pa 1976). 2007;32(19):2119-2126. doi:10.1097/BRS.0b013e318145a56a.
  5. Martin BI, Mirza SK, Comstock BA, Gray DT, Kreuter W, Deyo RA. Reoperation rates following lumbar spine surgery and the influence of spinal fusion procedures. Spine (Phila Pa 1976). 2007;32(3):382-387. doi:10.1097/01.brs.0000254104.55716.46.
  6. Young PM, Berquist TH, Bancroft LW, Peterson JJ. Complications of spinal instrumentation. Radiographics. 2007;27(3):775-789. doi:10.1148/rg.273065055
  7. El Saman A, Meier S, Sander A, Kelm A, Marzi I, Laurer H. Reduced loosening rate and loss of correction following posterior stabilization with or without PMMA augmentation of pedicle screws in vertebral fractures in the elderly. Eur J Trauma Emerg Surg. 2013;39(5):455-460. doi:10.1007/s00068-013-0310-6
  8. Galbusera F, Volkheimer D, Reitmaier S, Berger-Roscher N, Kienle A, Wilke HJ. Pedicle screw loosening: a clinically relevant complication?. Eur Spine J. 2015;24(5):1005-1016. doi:10.1007/s00586-015-3768-6
  9. Leitner L, Malaj I, Sadoghi P, et al. Pedicle screw loosening is correlated to chronic subclinical deep implant infection: a retrospective database analysis. Eur Spine J. 2018;27(10):2529-2535. doi:10.1007/s00586-018-5592-2
  10. Mörmann M, Thederan M, Nackchbandi I, Giese T, Wagner C, Hänsch GM. Lipopolysaccharides (LPS) induce the differentiation of human monocytes to osteoclasts in a tumour necrosis factor (TNF) alpha-dependent manner: a link between infection and pathological bone resorption. Mol Immunol. 2008;45(12):3330-3337. doi:10.1016/j.molimm.2008.04.022
  11. Puhvel SM, Reisner RM, Amirian DA. Quantification of bacteria in isolated pilosebaceous follicles in normal skin. J Invest Dermatol. 1975;65(6):525-531. doi:10.1111/1523-1747.ep12610239
  12. Berquist TH. Imaging of the postoperative spine. Radiol Clin North Am. 2006;44(3):407-418. doi:10.1016/j.rcl.2006.01.002.
  13. Wu JC, Huang WC, Tsai HW, et al. Pedicle screw loosening in dynamic stabilization: incidence, risk, and outcome in 126 patients. Neurosurg Focus. 2011;31(4):E9. doi:10.3171/2011.7.FOCUS11125
  14. Abul-Kasim, K., Ohlin, A. Evaluation of implant loosening following segmental pedicle screw fixation in adolescent idiopathic scoliosis: a 2 year follow-up with low-dose CT. Scoliosis 9, 13 (2014). https://doi.org/10.1186/1748-7161-9-13
  15. Lusins JO, Danielski EF, Goldsmith SJ. Bone SPECT in patients with persistent back pain after lumbar spine surgery. J Nucl Med. 1989;30(4):490-496.
  16. Even-Sapir E, Martin RH, Mitchell MJ, Iles SE, Barnes DC, Clark AJ. Assessment of painful late effects of lumbar spinal fusion with SPECT. J Nucl Med. 1994;35(3):416-422.
  17. Gates GF, McDonald RJ. Bone SPECT of the back after lumbar surgery. Clin Nucl Med. 1999;24(6):395-403. doi:10.1097/00003072-199906000-00004
  18. Sumer J, Schmidt D, Ritt P, et al. SPECT/CT in patients with lower back pain after lumbar fusion surgery. Nucl Med Commun. 2013;34(10):964-970. doi:10.1097/MNM.0b013e328363cf81
  19. McDonald M, Cooper R, Wang MY. Use of computed tomography-single-photon emission computed tomography fusion for diagnosing painful facet arthropathy. Technical note. Neurosurg Focus. 2007;22(1):E2. doi:10.3171/foc.2007.22.1.2
  20. Al-Riyami K, Vöö S, Gnanasegaran G, et al. The role of bone SPECT/CT in patients with persistent or recurrent lumbar pain following lumbar spine stabilization surgery. Eur J Nucl Med Mol Imaging. 2019;46(4):989-998. doi:10.1007/s00259-018-4141-x
  21. Carreon LY, Djurasovic M, Glassman SD, Sailer P. Diagnostic accuracy and reliability of fine-cut CT scans with reconstructions to determine the status of an instrumented posterolateral fusion with surgical exploration as reference standard. Spine (Phila Pa 1976). 2007;32(8):892-895. doi:10.1097/01.brs.0000259808.47104.dd
  22. Rutherford EE, Tarplett LJ, Davies EM, Harley JM, King LJ. Lumbar spine fusion and stabilization: hardware, techniques, and imaging appearances. Radiographics. 2007;27(6):1737-1749. doi:10.1148/rg.276065205
  23. Ryan PJ, Evans PA, Gibson T, Fogelman I. Chronic low back pain: comparison of bone SPECT with radiography and CT. Radiology. 1992;182(3):849-854. doi:10.1148/radiology.182.3.1531544
  24. Quinnell RC, Stockdale HR. Some experimental observations of the influence of a single lumbar floating fusion on the remaining lumbar spine. Spine (Phila Pa 1976). 1981;6(3):263-267. doi:10.1097/00007632-198105000-00008
  25. Galbusera F, Volkheimer D, Reitmaier S, Berger-Roscher N, Kienle A, Wilke HJ. Pedicle screw loosening: a clinically relevant complication?. Eur Spine J. 2015;24(5):1005-1016. doi:10.1007/s00586-015-3768-6
  26. Mörmann M, Thederan M, Nackchbandi I, Giese T, Wagner C, Hänsch GM. Lipopolysaccharides (LPS) induce the differentiation of human monocytes to osteoclasts in a tumour necrosis factor (TNF) alpha-dependent manner: a link between infection and pathological bone resorption. Mol Immunol. 2008;45(12):3330-3337. doi:10.1016/j.molimm.2008.04.022
  27. Rienmüller A, Borens O. Propionibacterium prosthetic joint infection: experience from a retrospective database analysis. Eur J Orthop Surg Traumatol. 2016;26(4):429-434. doi:10.1007/s00590-016-1766-y
  28. Dapunt U, Spranger O, Gantz S, et al. Are atrophic long-bone nonunions associated with low-grade infections?. Ther Clin Risk Manag. 2015;11:1843-1852. doi:10.2147/TCRM.S91532
  29. Haidar R, Najjar M, Der Boghossian A, Tabbarah Z. Propionibacterium acnes causing delayed postoperative spine infection: review. Scand J Infect Dis. 2010;42(6-7):405-411. doi:10.3109/00365540903582459
  30. Rquhart DM, Zheng Y, Cheng AC, et al. Could low grade bacterial infection contribute to low back pain? A systematic review. BMC Med. 2015;13:13. doi:10.1186/s12916-015-0267-x
  31. Carmen JC, Roeder BL, Nelson JL, et al. Treatment of biofilm infections on implants with low-frequency ultrasound and antibiotics. Am J Infect Control. 2005;33(2):78-82. doi:10.1016/j.ajic.2004.08.002
The Archives of Bone and Joint Surgery
Volume 11, Issue 12
December 2023
Pages 787-791

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History

  • Receive Date: 11 September 2023
  • Accept Date: 18 October 2023

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