CME 9 Session - EANM'14

Bone & Joint: Low Back Pain

Educational objectives:
After participating in this activity, attendees will:
  1. Have a thorough understanding of the anatomy, pathophysiology, pain clinical syndromes and epidemiology relevant to low back pain
  2. Recognise main bone SPECT/CT patterns and link them to most likely spinal conditions
  3. Be able to select and suggest appropriate state-of-the-art hybrid bone imaging as the preferred imaging technique for patients presenting with low back pain, according to clinical and patient characteristics
  4. Adapt SPECT-CT technical procedure and properly recognise complications presenting as post-operative low back pain in patients who underwent a spinal surgery
  5. Understand the stakes and challenges of low back pain in immune-compromised patients
Low back pain with or without radiculopathy is one the most frequently encountered health care problems and is a considerable source of health care expenses. Building on the successful symptom based approach introduced in last year’s CME on the limping patient, this educational activity will start with a review of the anatomy, pathophysiology, clinical presentation and epidemiology relevant to low back pain. Indications for nuclear medicine techniques (with an emphasis on SPECT/CT) and relationship with other imaging modalities and biochemical results will then be sketched out. Red flags, defined as a set of ominous clinical features, for low back pain will be discussed, and adapted/narrowed to SPECT/CT imaging.
SPECT-CT patterns at local (within vertebra), regional (within spine), and general (total skeleton) scales in connection with main aetiological conditions will be then delineated. Using clinical features and patient characteristics, a benefit-risk based imaging flow-chart will eventually be presented, highlighting the appropriate use of state-of-the-art hybrid imaging techniques in patients presenting with low back pain, with focus on bone SPECT-CT and PET-CT. The next part of this CME activity will tackle the challenging scenario of failed back surgery, outlining the role of hybrid bone imaging in patients with persisting or relapsed post-operative low back pain. Finally, the causes of low back pain, the imaging challenges, and the rationale for the radiopharmaceutical(s) choice facing the highrisk immune-compromised patient with low back pain will be discussed.

Key Words:
Low Back Pain, Bone Scintigraphy, SPECT-CT, PET-CT, Appropriate Use
Teaser Video
A short description by Frederic Paycha, chair of the EANM Bone & Joint Committee

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