Is CT (Computed Tomography)/SPECT (Single Photon Emission Computed Tomography) used to diagnose cervical spine pain?

CT/SPECT in Diagnosing Cervical Spine Pain

CT/SPECT is not recommended as a first-line imaging modality for diagnosing cervical spine pain, but may have value as a secondary test when initial imaging is inconclusive. 1

First-Line Imaging for Cervical Spine Pain

• For new or increasing nontraumatic cervical pain without "red flags," radiographs are the most appropriate initial imaging test, though therapy is rarely altered by radiographic findings in the absence of red flag symptoms 1
• MRI is the most sensitive test for detecting soft tissue abnormalities associated with neck pain but is not considered a first-line imaging modality due to high rates of abnormalities in asymptomatic individuals 1
• CT offers superior depiction of cortical bone compared to radiographs and is more sensitive in assessing facet degenerative disease, osteophyte formation, and joint capsular calcification, but is not recommended as a first-line examination for chronic neck pain without red flags 1

Role of SPECT/CT in Cervical Spine Pain

• There is no current role for nuclear medicine studies, including SPECT/CT, as the initial examination for cervical spine pain 1
• Tc-99m bone scan lacks both resolution and specificity in detecting pathology related to acute or worsening neck pain in the absence of red flag symptoms 1
• SPECT/CT may have value as a secondary imaging modality when initial imaging with MRI or CT is inconclusive 1, 2

Evidence Supporting Secondary Use of SPECT/CT

• A retrospective study demonstrated that hybrid SPECT/CT imaging identified potential pain generators in 92% of cervical spine scans in patients with non-conclusive MRI/CT findings 2
• SPECT/CT has shown promising results in localizing facet pain and potentially guiding treatment in patients with chronic neck pain with suspected facet pathology and equivocal MR and CT imaging findings 1
• Nearly half of patients with axial neck pain demonstrated zygapophyseal joint hypermetabolism (ZJH) on SPECT/CT imaging, supporting ZJH sites as potential pain generators and targets for treatment 3

Imaging Algorithm for Cervical Spine Pain

1. Initial evaluation with radiographs for new or increasing nontraumatic cervical pain without red flags 1
2. If red flags or radiculopathy are present, MRI is the preferred next imaging modality 1, 4
3. Consider SPECT/CT as a secondary test only when:
   • Initial imaging is inconclusive 2, 5
   • Facet joint arthropathy is suspected as a pain generator 2, 3
   • Planning targeted interventions such as facet joint injections 2, 5

Important Caveats

• Imaging findings must be interpreted in the context of clinical symptoms, as degenerative changes are common in asymptomatic individuals over age 30 4, 1
• The diagnostic accuracy of SPECT/CT is limited by variable self-attenuation, particularly in the cervical spine region due to high attenuation in the mandible, skull, and shoulders 6
• While SPECT/CT may help identify potential pain generators, its findings should guide but not replace clinical judgment in determining treatment 5, 3