# The Use of 18F-Fluoride Positron Emission Tomography/Computed Tomography Scanning to Identify Sources of Pain after Posterior Lumbar Interbody Fusion—An Analysis in Patients with and without Symptoms

## TL;DR

This study shows that 18F-fluoride PET/CT scans can better identify sources of pain after spinal fusion surgery compared to CT scans alone.

## Contribution

The study demonstrates the added value of 18F-fluoride PET/CT over CT in identifying pain sources after PLIF.

## Key findings

- Symptomatic patients showed abnormal PET values around screws and facet joints.
- PET/CT findings correlated better with symptoms than CT findings alone.
- Bone metabolism in operated segments reflects natural recovery during follow-up.

## Abstract

Background: Identifying the cause of recurrent or persisting pain after posterior lumbar interbody fusion (PLIF) is essential for establishing optimal treatment. In this study, we evaluate patients after PLIF surgery by 18F-fluoride PET/CT scans and patient-reported outcome measures (PROMs). Methods: A total of 36 PLIF patients were included. Sixty minutes after intravenous injection of 18F-fluoride, PET/CT scanning was performed. Bone graft ingrowth, subsidence, screw loosening and damage of facet joints were scored by quantifying the level of bone metabolism of the vertebral endplates in the disc spaces, around screws and around the facet joints on the PET scans. Results: In contrast to asymptomatic patients, symptomatic patients showed abnormal PET values around pedicle screws and/or facet joints and at the lower endplates of the disc spaces, identifying a possible source of pain. On CT, no significant differences between these two groups were found. Conclusion: The PET/CT findings appeared to correlate better with symptoms on PROMs compared to CT findings alone. When interpreting 18F-fluoride PET/CT findings after PLIF surgery, one should realize bone metabolism in the disc spaces of the operated segments and around pedicle screws or facet joint changes during follow-up, reflecting natural recovery.