264. Assessment of impact of single photon emission computed tomography (SPECT) on management of degenerative cervical and lumbar disease: a multi-institution survey of spine surgeons

BACKGROUND CONTEXT Use of SPECT for evaluation of the spine has been postulated to provide diagnostic information through localization of metabolic bone activity leading to clinically relevant pain and dysfunction. No study has prospectively assessed the impact of SPECT on clinical decision making in degenerative spinal disease. PURPOSE To evaluate whether the addition of SPECT in the multi-level degenerative spine results in changes to management plans compared to standard imaging in a multi-institutional survey of spine surgeons. STUDY DESIGN/SETTING Surgeon survey. PATIENT SAMPLE Twenty-seven spine surgeons participated in an online survey of 10 patient cases. OUTCOME MEASURES Change in treatment decision and invasiveness. METHODS Ten cases of degenerative spinal disease (7 lumbar and 3 cervical) were presented online with vignettes and relevant imaging. Surgeons selected a treatment category for each patient (pain management procedure (PM), surgery (S), or nonoperative (NO)). Based on answer choice they then selected a specific treatment plan (NO v PM v S), with surgical options ranging from least to most invasive. Cases were then reordered and presented with SPECT included. Percentage of treatment changes across cases was calculated. Management changes by surgeons were analyzed across decision categories: NO to S, NO to PM, PM to NO, PM to S, S to NO, and S to PM. RESULTS Twenty-seven spine surgeons completed both surveys totaling 540 responses. Respondents self-classified their practices as academic, private, or mixed (33.3% each). A total of 60.7% of surgeons stated they do not regularly use SPECT and of those 41.2% stated the primary reason was that they were unaware of its diagnostic utility in spine. Management decisions were changed 48% of the time with addition of SPECT to the work up with changes in overall treatment category 34% of the time. The number of treatment changes across decision categories was significant (p<0.001) with the majority of changes falling in the pm to S category (34%), followed by S to PM (30%), NO to PM (13%), NO to S (8%), and PM to NO (5%). Of the management changes with addition of SPECT, 42% were to a less invasive intervention (either surgical invasiveness or treatment category). CONCLUSIONS In evaluating patients with degenerative spinal disease, the use of SPECT may provide valuable additional information to guide decision making. In this survey the addition of SPECT resulted in surgeons changing their treatment to a less invasive intervention 42% of the time. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.