Frequency of Discordance between Facet Joint Activity on Technetium Tc99m Methylene Diphosphonate SPECT/CT and Selection for Percutaneous Treatment at a Large Multispecialty Institution

V.T. Lehman; R.C. Murphy; T.J. Kaufmann; F.E. Diehn; N.S. Murthy; J.T. Wald; K.R. Thielen; K.K. Amrami; J.M. Morris; T.P. Maus

doi:10.3174/ajnr.A3731

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Fig 1.
Number of lumbar facet joints per level with reported increased activity, total treated at that level with breakdown of those treated with and without activity. The left and right facet joints are grouped at each level.
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Fig 2.
Number of cervical facet joints per level with reported increased activity, total treated at that level with breakdown of those treated with and without activity. The left and right facet joints are grouped at each level.
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Fig 3.
Left-right discordance with treatment of side with no reported activity in addition to a side with activity in a 90-year-old woman with bilateral low back pain. ^99mTc MDP SPECT/CT demonstrates activity at the right, but not left, L3/L4 facet joint (A), and no reported increased activity at the bilateral L4/L5 facet joints (B) or other lumbar facet joints. Because of severe bilateral low back pain attributed to facet arthropathy, she underwent bilateral L3/L4 and L4/L5 facet joint injections.
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Fig 4.
Left-right discordance with absent treatment on a side with activity as well as level discordance in a 60-year-old woman with back pain and clinical findings supporting a left upper facet joint pain generator. Mildly increased activity in the left L1–L2 facet joint (A) and marked increased activity in the right L4–L5 facet joint (B). Only the left L1–L2 facet joint underwent facet joint steroid injection.

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Table 1:

Facet joint ^99mTc MDP activity, percutaneous treatment, and anatomic region

	Facet Joints Treated Percutaneously			Facet Joints Not Treated Percutaneously
	Lumbar (n = 156)	Cervical (n = 39)	Overall (n = 195)	Lumbar (n = 504)	Cervical (n = 227)	Overall (n = 731)
Activity present (%)	73 (47)	19 (49)	92 (47)	30 (6)	10 (4)	40 (5)
Activity absent (%)	83 (53)	20 (51)	103 (53)	474 (94)	217 (96)	691 (95)

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Table 2:

Reasons for discrepancy between facet joint activity and treatment

Reason	Patient Group
Reason	Lumbar (n = 41)	Cervical (n = 11)	Overall (n = 52)
Not documented (%)	18 (44)	3 (27)	21 (40)
Active facet joint not concordant with clinical findings (%)	13 (32)	5 (45)	18 (35)
Consideration of response (or lack of) to prior targeted treatment (%)	6 (15)	3 (27)	9 (17)
Relatively low reported activity (%)	2 (5)	0 (0)	2 (4)
Too many active facet joints to inject (%)	0 (0)	0 (0)	0 (0)
Information from other imaging (%)	2 (5)	0 (0)	2 (4)