{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:29:06Z","timestamp":1760059746313,"version":"build-2065373602"},"reference-count":41,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T00:00:00Z","timestamp":1751846400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Background\/Objectives: Diagnosis of Persistent Spinal Pain Syndrome Type 2 (PSPS-T2) currently lacks objective biomarkers. Therefore, this retrospective study aimed to investigate differences in glucose metabolism in the axial musculoskeletal system in PSPS-T2 patients by means of [18F]FDG PET-CT imaging. Methods: Nine PSPS-T2 patients (five females, four males; mean age of 53 \u00b1 4.82 years) and nine age- and gender-matched healthy controls (five females, four males; mean age of 53 \u00b1 3.91 years) were included. For each participant, 24 regions of interest (ROIs) were manually drawn, including areas of the vertebral endplates, the intervertebral discs, and the psoas muscles. For each ROI, the mean standardized uptake values (SUVs) were assessed. Group differences were evaluated using repeated measures ANOVA with Bonferroni-adjusted post-hoc pairwise comparisons. Additionally, Pearson correlation analyses examined associations between SUVmean values and the Numerical Rating Scale (NRS) pain scores. Results: Results demonstrated significantly higher SUVmean values in healthy controls compared to PSPS-T2 patients, particularly at the superior endplates of L4 and S1, the intervertebral discs at L4-L5 and L5-S1, and the posterior endplates of L4 and L5. Although PSPS-T2 patients exhibited higher SUVmean values than controls in the psoas muscle, these differences were not statistically significant. Additionally, no significant correlations were found between SUVmean values and NRS pain scores, suggesting that metabolic activity alone does not directly reflect pain severity. Conclusions: Despite the limited sample size of this pilot study, the metabolic fingerprint of the axial musculoskeletal system was shown to be distinctly different in PSPS-T2 patients compared to healthy controls. This could lead to an improved understanding of PSPS-T2 pathophysiology and might open new doors for better diagnosis and treatment strategies.<\/jats:p>","DOI":"10.3390\/brainsci15070724","type":"journal-article","created":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T10:03:27Z","timestamp":1751882607000},"page":"724","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["[18F]FDG PET-CT Imaging of the Low Back in Persistent Spinal Pain Syndrome Type 2: A Pilot Study Towards Improved Diagnosis"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-6463-959X","authenticated-orcid":false,"given":"Lara S.","family":"Burmeister","sequence":"first","affiliation":[{"name":"Department of Medical Imaging, Radboud University Medical Center, 6525GA Nijmegen, The Netherlands"},{"name":"Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, 6525GA Nijmegen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1110-840X","authenticated-orcid":false,"given":"Richard L.","family":"Witkam","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, 6525GA Nijmegen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2919-6356","authenticated-orcid":false,"given":"Kris C. P.","family":"Vissers","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, 6525GA Nijmegen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Gotthardt","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging, Radboud University Medical Center, 6525GA Nijmegen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3915-3034","authenticated-orcid":false,"given":"Dylan J. H. A.","family":"Henssen","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging, Radboud University Medical Center, 6525GA Nijmegen, The Netherlands"},{"name":"Department of Nuclear Medicine, University Hospital Leipzig, 04103 Leipzig, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"395","DOI":"10.3233\/BMR-150318","article-title":"The aetiologies of Failed Back Surgery Syndrome: A systematic review","volume":"30","author":"Clancy","year":"2017","journal-title":"J. Back Musculoskelet. Rehabil."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1093\/pm\/pnab015","article-title":"Persistent Spinal Pain Syndrome: A Proposal for Failed Back Surgery Syndrome and ICD-11","volume":"22","author":"Christelis","year":"2021","journal-title":"Pain Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1111\/j.1524-4733.2009.00588.x","article-title":"Relationship between health-related quality of life, pain, and functional disability in neuropathic pain patients with failed back surgery syndrome","volume":"13","author":"Manca","year":"2010","journal-title":"Value Health"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1111\/j.1533-2500.2009.00276.x","article-title":"Demographic characteristics of patients with severe neuropathic pain secondary to failed back surgery syndrome","volume":"9","author":"Thomson","year":"2009","journal-title":"Pain Pract."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"166","DOI":"10.12701\/jyms.2024.00339","article-title":"Failed back surgery syndrome-terminology, etiology, prevention, evaluation, and management: A narrative review","volume":"41","author":"Yeo","year":"2024","journal-title":"J. Yeungnam Med. Sci."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"3072","DOI":"10.1002\/art.24853","article-title":"Prevalence of and screening for serious spinal pathology in patients presenting to primary care settings with acute low back pain","volume":"60","author":"Henschke","year":"2009","journal-title":"Arthritis Rheum."},{"key":"ref_7","first-page":"Tc06","article-title":"Failed Back Surgery Syndrome: Evaluation with Magnetic Resonance Imaging","volume":"11","author":"Dhagat","year":"2017","journal-title":"J. Clin. Diagn. Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"n291","DOI":"10.1136\/bmj.n291","article-title":"Do not routinely offer imaging for uncomplicated low back pain","volume":"372","author":"Hall","year":"2021","journal-title":"BMJ"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1186\/s13244-022-01246-z","article-title":"The current role and future directions of imaging in failed back surgery syndrome patients: An educational review","volume":"13","author":"Witkam","year":"2022","journal-title":"Insights Imaging"},{"key":"ref_10","first-page":"74","article-title":"No association between MRI changes in the lumbar spine and intensity of pain, quality of life, depressive and anxiety symptoms in patients with low back pain","volume":"53","author":"Wawrzynek","year":"2019","journal-title":"Neurol. Neurochir. Pol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1386","DOI":"10.1166\/jmihi.2019.2782","article-title":"Potential Usefulness of Single Photon Emission Computed Tomography\/Computed Tomography in Management of Patients with Failed Back Surgery Syndrome","volume":"9","author":"Huang","year":"2019","journal-title":"J. Med. Imaging Health Inform."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1007\/s12306-017-0465-0","article-title":"Utility of 18F sodium fluoride PET\/CT imaging in the evaluation of postoperative pain following surgical spine fusion","volume":"101","author":"Pouldar","year":"2017","journal-title":"Musculoskelet. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1891","DOI":"10.1007\/s00259-015-3154-y","article-title":"Pseudarthrosis after lumbar spinal fusion: The role of 18F-fluoride PET\/CT","volume":"42","author":"Peters","year":"2015","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1177\/2192568219879087","article-title":"The Implications of Paraspinal Muscle Atrophy in Low Back Pain, Thoracolumbar Pathology, and Clinical Outcomes After Spine Surgery: A Review of the Literature","volume":"10","author":"He","year":"2020","journal-title":"Global Spine J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1016\/j.pmrj.2009.11.006","article-title":"The role of the lumbar multifidus in chronic low back pain: A review","volume":"2","author":"Freeman","year":"2010","journal-title":"PM&R"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1097\/00002517-199212000-00002","article-title":"The stabilizing system of the spine. Part II. Neutral zone and instability hypothesis","volume":"5","author":"Panjabi","year":"1992","journal-title":"J. Spinal Disord."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1111\/ner.13375","article-title":"Association of Outcomes of Spinal Cord Stimulation for Chronic Low Back Pain and Psoas Measurements Based on Size of Iliopsoas Muscles","volume":"25","author":"Sheldon","year":"2022","journal-title":"Neuromodulation"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1007\/s00259-014-2961-x","article-title":"FDG PET\/CT: EANM procedure guidelines for tumour imaging: Version 2.0","volume":"42","author":"Boellaard","year":"2015","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"623036","DOI":"10.1155\/2013\/623036","article-title":"The use of (18)F-FDG-PET\/CT for diagnosis and treatment monitoring of inflammatory and infectious diseases","volume":"2013","author":"Glaudemans","year":"2013","journal-title":"Clin. Dev. Immunol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1111\/cpf.12751","article-title":"PET\/CT imaging of spinal inflammation and microcalcification in patients with low back pain: A pilot study on the quantification by artificial intelligence-based segmentation","volume":"42","author":"Piri","year":"2022","journal-title":"Clin. Physiol. Funct. Imaging"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"381","DOI":"10.4103\/jcvjs.jcvjs_88_23","article-title":"Role of magnetic resonance imaging and 18-fluorodeoxyglucose positron emission tomography-computed tomography in identifying pain generators in patients with chronic low back pain","volume":"14","author":"Sharma","year":"2023","journal-title":"J. Craniovertebral Junction Spine"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"20220463","DOI":"10.1259\/bjr.20220463","article-title":"Non-oncologic incidental uptake on FAPI PET\/CT imaging","volume":"96","author":"Hotta","year":"2023","journal-title":"Br. J. Radiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1007\/s00586-012-2537-z","article-title":"The grading model for the assessment of the total amount of epidural fibrosis in postoperative lumbar spine","volume":"22","author":"Lubina","year":"2013","journal-title":"Eur. Spine J."},{"key":"ref_24","first-page":"E1219","article-title":"The Correlation of Epidural Fibrosis with Epiduroscopic and Radiologic Imaging for Chronic Pain after Back Surgery","volume":"24","author":"Guner","year":"2021","journal-title":"Pain Physician"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1016\/j.joca.2015.09.020","article-title":"Fibrotic-like changes in degenerate human intervertebral discs revealed by quantitative proteomic analysis","volume":"24","author":"Yee","year":"2016","journal-title":"Osteoarthr. Cartil."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2742","DOI":"10.1097\/00007632-200011010-00005","article-title":"Fibronectin and its fragments increase with degeneration in the human intervertebral disc","volume":"25","author":"Oegema","year":"2000","journal-title":"Spine (Phila Pa 1976)"},{"doi-asserted-by":"crossref","unstructured":"Tsai, Y.H., Huang, G.S., Tang, C.T., Chang, W.C., and Hsu, Y.C. (2022). 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., 9.","key":"ref_27","DOI":"10.3389\/fmed.2022.860545"},{"doi-asserted-by":"crossref","unstructured":"Ji, H., Song, X., Lv, X., Shao, F., Long, Y., Song, Y., Song, W., Qiao, P., Gai, Y., and Jiang, D. (2024). [68Ga]FAPI PET for Imaging and Treatment Monitoring in a Preclinical Model of Pulmonary Fibrosis: Comparison to [18F]FDG PET and CT. Pharmaceuticals, 17.","key":"ref_28","DOI":"10.3390\/ph17060726"},{"key":"ref_29","first-page":"100326","article-title":"The importance of psoas muscle on low back pain: A single-center study on lumbar spine MRI","volume":"18","author":"Mallio","year":"2024","journal-title":"N. Am. Spine Soc. J."},{"key":"ref_30","first-page":"E985","article-title":"Structural Changes of Lumbar Muscles in Non-specific Low Back Pain: A Systematic Review","volume":"19","author":"Goubert","year":"2016","journal-title":"Pain Physician"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1016\/j.spinee.2021.10.018","article-title":"Alteration of lumbar muscle morphology and composition in relation to low back pain: A systematic review and meta-analysis","volume":"22","author":"Seyedhoseinpoor","year":"2022","journal-title":"Spine J."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1093\/ajcn\/85.2.377","article-title":"Reduced physical activity increases intermuscular adipose tissue in healthy young adults","volume":"85","author":"Manini","year":"2007","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1002\/jcsm.12259","article-title":"Short-term disuse promotes fatty acid infiltration into skeletal muscle","volume":"9","author":"Pagano","year":"2018","journal-title":"J. Cachexia Sarcopenia Muscle"},{"doi-asserted-by":"crossref","unstructured":"Muellner, M., Haffer, H., Chiapparelli, E., Dodo, Y., Shue, J., Tan, E.T., Zhu, J., Pumberger, M., Sama, A.A., and Cammisa, F.P. (2023). Fat infiltration of the posterior paraspinal muscles is inversely associated with the fat infiltration of the psoas muscle: A potential compensatory mechanism in the lumbar spine. BMC Musculoskelet. Disord., 24.","key":"ref_34","DOI":"10.1186\/s12891-023-06967-w"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1080\/02688697.2020.1783434","article-title":"Reciprocal relationship between multifidus and psoas at L4-L5 level in women with low back pain","volume":"35","author":"Turgut","year":"2021","journal-title":"Br. J. Neurosurg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"6","DOI":"10.2174\/1570159X21666230808111908","article-title":"Peripheral Neuroinflammation and Pain: How Acute Pain Becomes Chronic","volume":"22","author":"Schumacher","year":"2024","journal-title":"Curr. Neuropharmacol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1097\/ALN.0000000000002130","article-title":"Neuroinflammation and Central Sensitization in Chronic and Widespread Pain","volume":"129","author":"Ji","year":"2018","journal-title":"Anesthesiology"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1483","DOI":"10.2147\/JPR.S306280","article-title":"Peripheral and Central Pathological Mechanisms of Chronic Low Back Pain: A Narrative Review","volume":"14","author":"Li","year":"2021","journal-title":"J. Pain Res."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1611","DOI":"10.1002\/ejp.1994","article-title":"A meta-analysis of the associations of elements of the fear-avoidance model of chronic pain with negative affect, depression, anxiety, pain-related disability and pain intensity","volume":"26","author":"Rogers","year":"2022","journal-title":"Eur. J. Pain"},{"doi-asserted-by":"crossref","unstructured":"Tsuji, T., Matsudaira, K., Sato, H., and Vietri, J. (2016). The impact of depression among chronic low back pain patients in Japan. BMC Musculoskelet. Disord., 17.","key":"ref_40","DOI":"10.1186\/s12891-016-1304-4"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1016\/j.pnpbp.2018.01.017","article-title":"Evaluating psychosocial contributions to chronic pain outcomes","volume":"87","author":"Meints","year":"2018","journal-title":"Prog. Neuropsychopharmacol. Biol. Psychiatry"}],"container-title":["Brain Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3425\/15\/7\/724\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:05:41Z","timestamp":1760033141000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3425\/15\/7\/724"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,7]]},"references-count":41,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["brainsci15070724"],"URL":"https:\/\/doi.org\/10.3390\/brainsci15070724","relation":{},"ISSN":["2076-3425"],"issn-type":[{"type":"electronic","value":"2076-3425"}],"subject":[],"published":{"date-parts":[[2025,7,7]]}}}