Articular facet osteoarthritis is a common cause of low back pain in adults. The facets can be a direct source of pain, as the synovial linings and joint capsules are richly innervated (12). Sciatica can be caused by nerve root compression due to facet hypertrophy, focal osteophytes, subluxation, or expansion of the joint capsule due to effusion (1).
SPECT imaging is more sensitive than planar imaging in detecting facet joint lesions (13-15) and can be used in selecting appropriate patients for treatment with facet injections (15,16). Ryan et al. compared SPECT imaging with radiography and CT in 34 patients with low back pain referred from a rheumatology clinic (14). SPECT identified 18 lesions of the facet joints. Seventeen of these corresponded to articular facet osteoarthritis on CT or radiography. Planar bone scintigraphy was positive in only two of these lesions. Holder et al. also compared SPECT and planar bone scintigraphy in the diagnosis of facet syndrome (15). All patients had anatomic evidence of facet arthritis as determined by CT, MRI, or radiography. The criteria for final diagnosis included clinical outcome and a sustained positive response to facet injection. Holder et al. found that SPECT was more sensitive (100% vs 76%) but less specific (71% vs 76%) than planar imaging in identifying clinically significant facet osteoarthritis. Scott et al. also found SPECT useful in selecting patients for facet injection (16). Facet joints showing increased tracer uptake had sustained responses to treatment.
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