Bone SPECT scans in PP?

[manowar rules]

How much are people using Bone SPECT scans in private practice? In my fellowship they are used quite a bit to isolate active facet inflammation. I generally only use them for cervicals because, to be honest, I have a hard time distinguishing facet synovitis in the cervical region unless there is a huge difference between levels.

But in a couple months I will be going to start job in a smaller town (pop ~50k) where it might be a hassle to get a SPECT done.

What would be the the other option? Do MBBs on a clinically suspected level or two at a time?

Thanks

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[drpainfree]

What kind of fellowship are you doing? Private or University? ACGME-accredited or not?

 

[manowar rules]

ACGME accredited, private.

 

[Taus]

Very rarely. Use your clinical judgment and evidence with tenderness, referral maps, prevalence data, and rarely/lastly X-ray/MRI to isolate the level or 2. No good studies back up spect. The better ones show it's not really that helpful. Mbb at suspected levels, often 2 contiguous in c spine. May adjust up or down if only partial relief.


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[SeniorWrangler]

SPECT is not that great for recognizing facet disease according to the literature; SPECT-CT is better but that is more expensive and more radiation for the patient.

 

[Aether2000]

It doesn't matter if you want a Spect or a Spect-CT- most insurers will not cover it.

 

[paintrain]

We see it not uncommonly as well. ACGME-accredited, university-based. Usually in the setting of non-radicular neck pain s/p TPI's, 1-2 MBB's without significant relief. The bone SPECT will come back with isolated facet disease somewhere else in the cervical spine. We'll MBB/RFL that area improved relief. I thought it overkill at the time but when you're relatively certain it's facet synovitis but haven't had good luck with a few MBBs, the bone SPECT was helpful in directing the injection. FWIW, N=3

So no one else in PP is using this?

 

[SSdoc33]

you might as well just give your patients cancer....

1. few insurers will pay for it
2. necessary radiation
3. if you know what you are doing, they very rarely necessary

 

[NOSfan]

So no one else in PP is using this?

SPECT/CT can be useful.

 

[SSdoc33]

you can just do a multi-level block. add another level if you are really confused. do you really need to zap them with radiation to figure it out? just poke em where it hurts.

 

[Ducttape]

Does the SPECT scam provide any useful information you would not get with a MBB, particularly since you can use the MBB as "staging" for treatment for RFA...


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[manowar rules]

Great information, thanks!

 

[jonnylingo]

Does the SPECT scam provide any useful information you would not get with a MBB, particularly since you can use the MBB as "staging" for treatment for RFA...


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Not sure if that was intentional

I ordered these frequently in PP right out of training. Rarely if ever gave useful info. Area of increased uptake rarely correlated with patient's pain referral pattern. Rarely correlated with MBB relief.

Lots of radiation (~60 Xrays). Don't order anymore.

MRI with STIR will light up hot facet.