PET/CT is highly effective for the evaluation of pain after spinal surgery

[Justin]

Below is an article in the Radiological Society of North America News that I read every month. While the picture is very interesting to look at (it won an award), for most Spine Patient I felt that the imaging mentioned--PET/CT scans--could possibly provide answers to those experiencing ongoing pain due to spine hardware.

PET = Positron emission tomography
CT = X-ray computed tomography
_______________________________
RSNA News
July 2011, Volume 21, Issue 7, Page 19
Copyright © 2011 Radiological Society of North America, Inc.

Click here for the color PDF of the article to view image of spinal hardware

18F-NaF PET/CT Evaluation of Cervical Spine Fixation Hardware
PET/CT Evaluation of Spinal Fixation Hardware Named SNM Image of the Year

The Society of Nuclear Medicine’s (SNM) 2011 Image of the Year illustrates the ability of PET/CT scans to identify abnormal bone reaction in patients who have received spinal fixation hardware implants (my underlining). Researchers selected this image from more than 1,800 studies presented over the course of four days during the SNM annual meeting in San Antonio in June.

Each year, SNM chooses an image that exemplifies the most cutting-edge molecular imaging research and demonstrates the ability of molecular imaging to detect and diagnose disease and help select the most appropriate therapy.

Andrew Quon, M.D., assistant professor of radiology and chief of clinical PET/CT for the molecular imaging program at Stanford University in Stanford, Calif., and lead author of the study that yielded this year’s image, said the image “reminds us that the future of molecular imaging lies not just in cancer imaging but in a wide range of disease processes beyond onco- logic applications.”

For the prospective study, 20 patients presenting with spinal pain were evaluated with PET/CT using F-18 sodium fluoride (NaF) at least eight months after surgery. A total of 24 bone or tissue abnormalities were found in 17 of the 20 subjects. Of the original 20 patients, 12 received exploratory surgery and four participants received local anesthetic nerve blockade, a common and minimally invasive treatment that numbs the affected nerve, providing short-term pain management as an alternative to surgery. The research indicated that F-18 NaF PET/CT is highly effective for the evaluation of pain after spinal surgery—in more than 85 percent of cases, the exact source of patient’s pain was identified (my underlining and bold).

[mwolf2022]

Justin do you know if the PET/CT is widely available yet.I am going on 3 years with no diagnosis , and feel I would greatly benefit from this exam.

Thank You

Mike

[Justin]

Justin do you know if the PET/CT is widely available yet.I am going on 3 years with no diagnosis , and feel I would greatly benefit from this exam.

Thank You

Mike

Hey Mike,

A traditional PET scan is widely used to detect bone metastases (spread of cancer to bone). It is widely available, but I don't think it is used to look at the spine after hardware "failure" outside of clinical trials or research studies.

This is especially true for the 18F-NaF PET/CT in particular:

Centers for Medicare and Medicaid Services (CMS) coverage for the 18F NaF PET biomarker, which includes coverage for initial treatment strategy or subsequent treatment strategy for suspected or biopsy proven bone metastasis. To be covered, the indication must be in the context of a clinical study and both the patient and imaging services provider must be enrolled in the registry. (Positron Emission Tomography (NaF-18) to Identify Bone Metastasis of Cancer.Medicare National Coverage Determinations Manual; Transmittal 119; March 26, 2010)

Since it is primarily used to detect cancer metastases to the bone, there will most likely be an issue with having insurance cover the procedure. See the website below, it has a lot of great information:

• Who are the best patient candidates to receive a 18F NaF PET/CT bone scan?
• PET/CT imaging with 18F NaF is a good alternative to traditional bone scans

Mike, since you have been suffering for 3 years without an answer, it might be worthwhile to contact someone at Cardinal Health (website here) to see if the 18F NaF PET/CT bone scan has used "off label" for spine pathology (ongoing pain post hardware placement) with successful reimbursement for physicians.

Good luck and I hope this helps.