Bildgebende Darstellung bewegungsgestörter Halswirbelsäulensegmente mittelsSingle-Photon-Emission-Computed-Tomographie

Aim: No generally accepted scientific evidence for hypomobility of intervertebral joints based on imaging techniques is available to date. The diagnosis can only be made by an examination performed by a physiotherapist. We examined patients with spinal hypomobilities by bone scintigraphy (BS) to determine whether changes in bone metabolism of intervertebral joints could be detected in comparison to normal controls. Patients and Methods: Included into the prospective study were patients with hypomobilities of the cervical spine as diagnosed by an experienced physiotherapists in 2004. The control group consisted of patients that underwent BS for other reasons matching the experimental group in respect to age and sex. Spinal hypomobility was determined by 12 standardized examinations of intervertebral joint mobility and total cervical mobility and by an ultrasound-based computerized system (ZEBRIS CMS 20S, Zebris GmbH, Tuebingen, Germany). X-rays and MRI of the cervical spine were used to exclude degenerative disease or any other pathological process. In addition to planar whole body images, SPECT images of the cervical spine were obtained. A standardized side-by-side ROI-based approach was used for semiquantitative analysis of bone metabolism in all cervical segments. Results: 25 patients aged 18-37 years were included into the study, 12 with cervical spine hypomobilities and 13 as control. If the ratio of the spinal ROIs is set to 1.2 or higher, the diagnosis of hypomobility could be made with a sensitivity of 83.3% and a specificity of 92.3%. Changes in bone metabolism were evident not only in the hypomobile segment but also in specific pattern in the whole cervical spine. Differences in the uptake ratios between cervical segments varied significantly stronger in patients with hypomobilities (p<0.05). No pathology could be found in x-rays or MRI scans of any of the patients. Conclusion: BS is the first imaging method that is able to demonstrate significant differences between healthy and hypomobile spines. This is important because it provides objective scientific evidence for the existence of spinal hypomobilities. Furthermore, this technique may also be used in the evaluation of traumatic hypomobilities (whiplash syndrome), as this could be a technique for objective disease assessment in legal matters.