Ryan P J, Evans P, Gibson T, Fogelman I
Department of Nuclear Medicine, Guy's Hospital, London, England.
J Bone Miner Res. 1992 Dec;7(12):1455-60. doi: 10.1002/jbmr.5650071213.
A group of 26 patients aged 47-81 years (average 67) with spinal osteoporosis and back pain for more than 6 months were investigated with planar and SPECT bone scintigraphy and anterior and lateral x-rays of the thoracolumbar spine. Abnormal activity on bone scintigraphy was found in all patients, of whom 22 had multiple lesions. A total of 17 (65%) patients had abnormal activity associated with collapsed vertebral bodies, 5 (19%) had degenerative disk disease, and 21 (81%) had facetal joint disease. Of 112 lesions identified by SPECT, 60 (54%) were localized to the apophyseal joints. Facetal lesions were commoner in those patients with more collapsed vertebrae, and 32 facetal lesions (54%) were associated with collapse of the vertebra immediately above or below. Bone scintigraphy findings suggest that in some individuals with osteoporosis and chronic back pain, collapse of the vertebral body or degenerative disk disease are causes of pain. However, the high frequency of increased apophyseal joint activity suggests that the facet joint may also be an important site of origin of pain in these individuals. Bone scintigraphy may identify a subgroup of osteoporotic patients with chronic back pain who would benefit from treatment to the facet joints.
对一组26例年龄在47 - 81岁（平均67岁）、患有脊柱骨质疏松症且背痛超过6个月的患者进行了平面和SPECT骨闪烁显像以及胸腰椎前后位和侧位X线检查。所有患者骨闪烁显像均发现异常活动，其中22例有多处病变。共有17例（65%）患者的异常活动与椎体塌陷有关，5例（19%）有椎间盘退变疾病，21例（81%）有小关节疾病。在SPECT识别出的112处病变中，60处（54%）局限于骨突关节。椎体塌陷较多的患者中，小关节病变更为常见，32处小关节病变（54%）与紧邻的上方或下方椎体塌陷有关。骨闪烁显像结果表明，在一些患有骨质疏松症和慢性背痛的个体中，椎体塌陷或椎间盘退变疾病是疼痛的原因。然而，骨突关节活动增加的高频率表明，小关节也可能是这些个体疼痛的重要起源部位。骨闪烁显像可能识别出一组患有慢性背痛的骨质疏松症患者，他们将从小关节治疗中获益。
