Primary pain generator identification by CT–SPECT in a patient with low back pain: a case reportReportar como inadecuado

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BMC Research Notes

, 10:132

First Online: 21 March 2017Received: 29 January 2016Accepted: 17 March 2017DOI: 10.1186-s13104-017-2458-3

Cite this article as: Tender, G., Constantinescu, A., Conger, A. et al. BMC Res Notes 2017 10: 132. doi:10.1186-s13104-017-2458-3


BackgroundChronic low back pain is one of the most common conditions encountered in the middle-age population. Identifying the primary pain generator is notoriously difficult. The computed tomography–single-photon emission computed tomography CT–SPECT is emerging as a new diagnostic modality for this purpose.

Case presentationThis 68-year-old Caucasian male presented with intractable low back pain refractory to maximal conservative treatment, including medication and extensive physical therapy. The lumbar computed tomography, magnetic resonance imaging, and flexion–extension X-rays showed advanced degenerative changes throughout the lumbar spine, but no single level significantly worse than the others. The CT–SPECT showed markedly increased uptake at the L1–2 disc level and only minimal uptake at the other levels. The patient underwent a minimally invasive lateral L1–2 fusion with near-complete resolution of his low back pain.

ConclusionsThe CT–SPECT may provide a unique tool in establishing the primary pain generator in patients with degenerative spine disease.

KeywordsCT–SPECT Degenerative spine Low back pain Primary pain generator AbbreviationsCT–SPECTcomputed tomography–single-photon emission computed tomography

CTcomputed tomography

MRImagnetic resonance imaging

LBPlow back pain

CBCcomplete blood count

BMPbasic metabolic panel

PTprothrombin time

PTTpartial thromboplastin time


Autor: Gabriel Tender - Adriana Constantinescu - Andrew Conger - Anthony DiGiorgio


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