Bone Scan

[GatorCHOMPions]

I never ordered a bone scan in training, but a pain doc in my current locale did one on a patient with prior cervical fusion. There was “slight” increased uptake at a level in the thoracic spine that they then did MBB/RFA and patient apparently had a good outcome.

It got me thinking if I should be ordering them. Was the above a good example? What are some other examples where it could assist with patient care? I scanned the forum and saw several piecemeal examples but would be good to consolidate into one place.

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[drrosenrosen]

Bone scan is a good way to assess acuity of compression fracture if they can't have an MRI. You'd still do well to have a CT to assess morphology/ rule out retropulsion

 

[Agast]

I’ve had workers compensation require a triple nucleotide bone scan for CRPS work up before they would approve a sympathetic block

 

[vadim1980]

I never ordered a bone scan in training, but a pain doc in my current locale did one on a patient with prior cervical fusion. There was “slight” increased uptake at a level in the thoracic spine that they then did MBB/RFA and patient apparently had a good outcome.

It got me thinking if I should be ordering them. Was the above a good example? What are some other examples where it could assist with patient care? I scanned the forum and saw several piecemeal examples but would be good to consolidate into one place.

I sometimes get a bone scan to track the progression of a compression fracture, instead of ordering a repeat MRI, which may not be approved. Also as mentioned a bone scan if MRI is contra indicated. A lot of time increase up take will be in posterior elements in arthritic conditions. Not sure if it’s worth doing as info for potential mbb or other similar treatments though

 

[SSdoc33]

ill save you some time:

no. you should be able to make the dx with conventional imaging and not expose the pt to more radiation

 

[BobBarker]

Use them to check for loose knee hardware. Order a few per year.

 

[RoloTomassi]

Can help detect pseudarthrosis at fused segment.

Can help determine if adjacent disease above or below a fused segment is more symptomatic.

Bone lesions.

 

[Orin]

They're less utilized in the states for sure but it's an easy fast scan to get. I use them for the odd facet joint that doesn't fit the usual referral pattern, VCFs in patients that can't get an MRI, or cancer folks.

I'll sometimes order them on my fibromyalgia patients to help them understand it isn't all arthritis using images showing equivalent uptake across all the joints.

If I'm trying to be fancy, I order a CT-SPECT which gets me the bone signal overlaid against a low energy CT scan cross-sectional data but that's more for things around hardware or maybe a weird kypho to help with planning.

It's less radiation than a CT chest or Abd/Pelvis. It's cheaper. It doesn't have the sedation/claustrophobia/stay still needs. It doesn't have the metal artifacts as much.

 

[interjectionreflection]

Bone scan is a good way to assess acuity of compression fracture if they can't have an MRI. You'd still do well to have a CT to assess morphology/ rule out retropulsion

If retropulsion with contact of cord or nerve root but no neurological symptoms would you still send to surgeon? In training we never really sent to a surgeon unless obvious radiculopathy or myleopathy but curious about the case of contact but just axial pain

 

[lobelsteve]

If retropulsion with contact of cord or nerve root but no neurological symptoms would you still send to surgeon? In training we never really sent to a surgeon unless obvious radiculopathy or myleopathy but curious about the case of contact but just axial pain

Would kypho unless neurological compromise.