The use of SPECT-CT in the evaluation of lumbar spine pathology - A Narrative Review.

Introduction: Chronic low back pain is frequently associated with multilevel degenerative abnormalities that may not identify the symptomatic structure. Single-photon emission computed tomography combined with computed tomography (SPECT-CT) combines metabolic and anatomical imaging and has been proposed as an adjunct where conventional imaging is inconclusive. Research question: To critically assess current evidence concerning the diagnostic and clinical utility of SPECT-CT in lumbar degenerative pathology. Materials and methods: PubMed was searched for English-language publications dated from 2000 to 2025 concerning SPECT-CT, lumbar pathology and low back pain. Primary clinical studies, technical studies, relevant reviews and guidelines were synthesised narratively, with direct and contextual evidence distinguished. Results: The evidence base is heterogeneous and predominantly observational. SPECT-CT can anatomically localize sites of increased osseous tracer uptake and may provide additional information in selected diagnostically challenging cases. However, interpretation is limited by non-standardised positivity thresholds, interobserver variability, discordance with MRI, imperfect agreement with diagnostic blocks, absence of a validated reference standard and limited controlled evidence that SPECT-CT-guided management improves outcomes. Discussion and conclusion: SPECT-CT may have an adjunctive role in carefully selected patients with unresolved diagnostic uncertainty where the result is likely to alter management. Current evidence is insufficient to support routine use or to conclude that SPECT-CT independently identifies the true pain source, improves treatment selection or improves outcomes over conventional diagnostic pathways.