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Abstract
In this prospective study with independent clinical review, reported results of scintigraphy were compared to clinical examination findings and patient symptoms to determine if there was a correlation between a high level of uptake of radioactive tracer and the source of intractable, axial, unilateral neck pain in 32 consecutive patients, 19 males and 13 females, whose average age was 63 years (range 34-80). The findings were gathered over a 7 year period, giving up to 7 years follow-up. The purpose was to ascertain whether scintigraphy is useful in the diagnosis and treatment of intractable, unilateral, axial neck pain.
Adults presenting with intractable unilateral axial neck pain, persistent for an average of 15 months (3-86) were offered scintigraphy. The patient’s scans were reviewed to determine if there was a correlation between clinical findings and scintigraphy. If there was, patients were admitted to the study and went on to have specific injections and manipulation to the facet joints identified as potentially inflamed. The patients were initially reviewed at one month and then independently interviewed by telephone at an average of 4 years 1 month (range 1 month-7 years) post-injection, to determine the longer term results of this intervention.
Scintigraphy identified correlating ‘hot spots’ suggestive of facet joint inflammation, which facilitated site specific injections under x-ray control and manipulation. Other than one patient, who turned out to have multiple myeloma, 26 (81%) of the remaining 32 patients who were reviewed at one month had significant pain relief. Long term follow up was only possible on 22 (69%) of the original 32 patients admitted to this study. Of these, 19 patients (86%) had long term pain relief.
This study suggests that scintigraphy may be useful in identifying the source of intractable, unilateral axial neck pain and guiding specific corticosteroid injections for chronic pain relief.