{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:09:08Z","timestamp":1783037348181,"version":"3.54.6"},"reference-count":42,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"26","license":[{"start":{"date-parts":[[2024,12,23]],"date-time":"2024-12-23T00:00:00Z","timestamp":1734912000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cosmet Laser Ther"],"published-print":{"date-parts":[[2024,12,23]]},"abstract":"\n BACKGROUND<\/jats:title>\n \n The inability to localize pain generators often results in failed back surgery syndrome (FBSS). Structural imaging can identify multiple and\/or noncausative abnormalities. Molecular imaging of glucose transporters offers the opportunity to localize metabolically active sites. Using the radiotracer [\n 18<\/jats:sup>\n F]fluorodeoxyglucose (FDG) with positron emission tomography\/magnetic resonance imaging (PET\/MRI) has enabled the localization of malignant lesions and pain generators via regions of high inflammation.\n <\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n A 61-year-old woman was diagnosed with complex regional pain syndrome (CRPS) and experienced right greater than left upper-extremity pain. Following PET\/MRI with the FDG radioligand for GLUT, increased radiotracer uptake was seen in the right C6 nerve root and dorsal root ganglion, providing additional information to the structural MRI findings of narrowing of the right C5\u20136 neural foramina. Together with pain relief following a transforaminal steroid injection to the area, these results prompted the authors to perform a C5\u20136 anterior cervical discectomy and fusion procedure, which resulted in significant symptom relief.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n The authors present a case of worsening upper-extremity CRPS with an occult radiculopathy that improved following surgery to address a pain generator identified by FDG PET\/MRI. Localization of inflammatory sites can reduce FBSS and nonspecific management of pain believed to be resulting from spinal pain generators in a wide array of chronic pain syndromes.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE24327<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case24327","type":"journal-article","created":{"date-parts":[[2024,12,23]],"date-time":"2024-12-23T01:48:45Z","timestamp":1734918525000},"source":"Crossref","is-referenced-by-count":2,"title":["Treatment of occult radiculopathy in complex regional pain syndrome by anterior cervical discectomy and fusion following localization by [18F]fluorodeoxyglucose radioligand and PET\/MRI: illustrative case"],"prefix":"10.3171","volume":"8","author":[{"given":"Ethan","family":"Schonfeld","sequence":"first","affiliation":[{"name":"Neurosurgery Artificial Intelligence Lab, Stanford University School of Medicine, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ghani","family":"Haider","sequence":"additional","affiliation":[{"name":"Neurosurgery Artificial Intelligence Lab, Stanford University School of Medicine, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivianne","family":"Tawfik","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael C.","family":"Jin","sequence":"additional","affiliation":[{"name":"Neurosurgery Artificial Intelligence Lab, Stanford University School of Medicine, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly","family":"Yoo","sequence":"additional","affiliation":[{"name":"Departmentof Neurosurgery, Stanford University School of Medicine, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neelan J.","family":"Marianayagam","sequence":"additional","affiliation":[{"name":"Departmentof Neurosurgery, Stanford University School of Medicine, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandip","family":"Biswal","sequence":"additional","affiliation":[{"name":"University of Wisconsin School of Medicine and Public Health, University of Wisconsin\u2013Madison, Madison, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anand","family":"Veeravagu","sequence":"additional","affiliation":[{"name":"Neurosurgery Artificial Intelligence Lab, Stanford University School of Medicine, Stanford, California"},{"name":"Departmentof Neurosurgery, Stanford University School of Medicine, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"3","key":"bib1","series-title":"Pain","first-page":"194","article-title":"Opioid therapy for nonspecific low back pain and the outcome of chronic work loss","volume":"142","author":"Volinn","year":"2009","unstructured":"Volinn EFargo JDFine PG. Opioid therapy for nonspecific low back pain and the outcome of chronic work loss. Pain. 2009;142(3):194-201."},{"key":"bib2","series-title":"BMJ","first-page":"n291","article-title":"Do not routinely offer imaging for uncomplicated low back pain","volume":"372","author":"Hall","year":"2021","unstructured":"Hall AMAubrey-Bassler KThorne BMaher CG. Do not routinely offer imaging for uncomplicated low back pain. BMJ. 2021;372:n291."},{"issue":"4","key":"bib3","series-title":"Pain Med","first-page":"577","article-title":"Failed back surgery syndrome","volume":"12","author":"Chan","year":"2011","unstructured":"Chan CWPeng P. Failed back surgery syndrome. Pain Med. 2011;12(4):577-606."},{"issue":"1","key":"bib4","series-title":"Semin Oncol","first-page":"55","article-title":"Metabolic PET imaging in cancer detection and therapy response","volume":"38","author":"Zhu","year":"2011","unstructured":"Zhu ALee DShim H. Metabolic PET imaging in cancer detection and therapy response. 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Clinical features and pathophysiology of complex regional pain syndrome\u2014current state of the art. Lancet Neurol. 2011;10(7):637-648."},{"issue":"1","key":"bib19","series-title":"J Neuroinflammation","first-page":"162","article-title":"Expression profiling of spinal cord dorsal horn in a rat model of complex regional pain syndrome type-I uncovers potential mechanisms mediating pain and neuroinflammation responses","volume":"17","author":"Chen","year":"2020","unstructured":"Chen RYin CHu Q, et al. Expression profiling of spinal cord dorsal horn in a rat model of complex regional pain syndrome type-I uncovers potential mechanisms mediating pain and neuroinflammation responses. 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Front Nucl Med. 2022;2:847810."},{"issue":"1","key":"bib8","series-title":"Br Med Bull","first-page":"55","article-title":"F-18 FDG PET\/CT imaging of cardiac and vascular inflammation and infection","volume":"120","author":"Lawal","year":"2016","unstructured":"Lawal ISathekge M. F-18 FDG PET\/CT imaging of cardiac and vascular inflammation and infection. Br Med Bull. 2016;120(1):55-74."},{"issue":"1","key":"bib9","series-title":"Arthritis Res Ther","first-page":"251","article-title":"The inflammatory response in the regression of lumbar disc herniation","volume":"20","author":"Cunha","year":"2018","unstructured":"Cunha CSilva AJPereira PVaz RGon\u00e7alves RMBarbosa MA. The inflammatory response in the regression of lumbar disc herniation. Arthritis Res Ther. 2018;20(1):251."},{"issue":"3","key":"bib10","series-title":"AJNR Am J Neuroradiol","first-page":"332","article-title":"[18F]FDG-PET evaluation of spinal pathology in patients in oncology: pearls and pitfalls for the neuroradiologist","volume":"43","author":"Patel","year":"2022","unstructured":"Patel PYDalal IGriffith B. [18F]FDG-PET evaluation of spinal pathology in patients in oncology: pearls and pitfalls for the neuroradiologist. AJNR Am J Neuroradiol. 2022;43(3):332-340."},{"issue":"5","key":"bib11","series-title":"Pain","first-page":"968","article-title":"Neuroinflammation of the spinal cord and nerve roots in chronic radicular pain patients","volume":"159","author":"Albrecht","year":"2018","unstructured":"Albrecht DSAhmed SUKettner NW, et al. Neuroinflammation of the spinal cord and nerve roots in chronic radicular pain patients. Pain. 2018;159(5):968-977."},{"key":"bib12","series-title":"World Neurosurg","first-page":"114","article-title":"Pathologic basis of lumbar radicular pain","volume":"128","author":"Dower","year":"2019","unstructured":"Dower ADavies MAGhahreman A. Pathologic basis of lumbar radicular pain. World Neurosurg. 2019;128:114-121."},{"key":"bib13","series-title":"Spinal Cord Ser Cases","first-page":"81","article-title":"18F-FDG-PET\/CT localizes intervertebral disc space infection following posterior lumbar interbody fusion surgery leading to successful retention of percutaneously inserted pedicle screws: a case report","volume":"4","author":"Haraya","year":"2018","unstructured":"Haraya KYamada KKokabu T, et al. 18F-FDG-PET\/CT localizes intervertebral disc space infection following posterior lumbar interbody fusion surgery leading to successful retention of percutaneously inserted pedicle screws: a case report. Spinal Cord Ser Cases. 2018;4:81."},{"key":"bib14","series-title":"Front Med","article-title":"Case report: nerve root entrapment due to epidural fibrosis in a patient with failed back surgery syndrome: value of 2-18F-fluorodeoxyglucose simultaneous positron emission tomography-magnetic resonance imaging","volume":"9:860545","author":"Tsai","year":"2022","unstructured":"Tsai YHHuang GSTang CTChang WCHsu YC. Case report: nerve root entrapment due to epidural fibrosis in a patient with failed back surgery syndrome: value of 2-18F-fluorodeoxyglucose simultaneous positron emission tomography-magnetic resonance imaging. Front Med. 2022;9:860545."},{"issue":"2","key":"bib15","series-title":"Br J Anaesth","first-page":"e424","article-title":"Complex regional pain syndrome: a narrative review for the practising clinician","volume":"123","author":"Shim","year":"2019","unstructured":"Shim HRose JHalle SShekane P. Complex regional pain syndrome: a narrative review for the practising clinician. Br J Anaesth. 2019;123(2):e424-e433."},{"issue":"2","key":"bib16","series-title":"J Surg Orthop Adv","first-page":"117","article-title":"Complex regional pain syndrome","volume":"25","author":"Ersoy","year":"2016","unstructured":"Ersoy HPomeranz SJ. Complex regional pain syndrome. J Surg Orthop Adv. 2016;25(2):117-120."},{"issue":"6","key":"bib17","series-title":"Asian Spine J","first-page":"921","article-title":"Cervical radiculopathy focus on characteristics and differential diagnosis","volume":"14","author":"Kang","year":"2020","unstructured":"Kang KCLee HSLee JH. Cervical radiculopathy focus on characteristics and differential diagnosis. Asian Spine J. 2020;14(6):921-930."},{"issue":"7","key":"bib18","series-title":"Lancet Neurol","first-page":"637","article-title":"Clinical features and pathophysiology of complex regional pain syndrome\u2014current state of the art","volume":"10","author":"Marinus","year":"2011","unstructured":"Marinus JMoseley GLBirklein F, et al. Clinical features and pathophysiology of complex regional pain syndrome\u2014current state of the art. Lancet Neurol. 2011;10(7):637-648."},{"issue":"1","key":"bib19","series-title":"J Neuroinflammation","first-page":"162","article-title":"Expression profiling of spinal cord dorsal horn in a rat model of complex regional pain syndrome type-I uncovers potential mechanisms mediating pain and neuroinflammation responses","volume":"17","author":"Chen","year":"2020","unstructured":"Chen RYin CHu Q, et al. Expression profiling of spinal cord dorsal horn in a rat model of complex regional pain syndrome type-I uncovers potential mechanisms mediating pain and neuroinflammation responses. J Neuroinflammation. 2020;17(1):162."},{"key":"bib20","series-title":"J Pain Res","first-page":"2353","article-title":"Successful treatment of chronic knee pain following localization by a sigma-1 receptor radioligand and PET\/MRI: a case report","volume":"11","author":"Cipriano","year":"2018","unstructured":"Cipriano PWLee SWYoon D, et al. Successful treatment of chronic knee pain following localization by a sigma-1 receptor radioligand and PET\/MRI: a case report. J Pain Res. 2018;11:2353-2357."},{"issue":"suppl","key":"bib21","series-title":"J Nucl Med","first-page":"143","article-title":"S1R PET\/MRI of patients with chronic knee pain reveals potential pain generators not otherwise identified with standard care: early experience","volume":"62","author":"Yoon","year":"2021","unstructured":"Yoon LYoon PYoon D, et al. S1R PET\/MRI of patients with chronic knee pain reveals potential pain generators not otherwise identified with standard care: early experience. 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