Fifty-four patients (mean age: 51.02 ± 10.59 years) were enrolled. SPECT/CT demonstrated significantly higher detection rates of pain generators compared to planar imaging (96.3% vs. 83.3%, p = 0.001). Cases with high tracer uptake showed significantly more frequent combined screw and facet joint involvement (65.5%, p ≤ 0.001). SPECT/CT findings modified management in 66.7% of the patients studied. Significant progressive improvements were observed in both VAS scores (from 2.98 ± 0.14) and ODI scores (from 49.2 ± 7.8) pre-intervention to (1.10 ± 0.46, p < 0.001) and (20.56 ± 5, p < 0.001), respectively, in the 6^th month post-intervention. Intensity of tracer uptake on SPECT/CT was a significant independent predictor for both pain improvement (OR = 2.10, 95% CI [1.22–3.63], p = 0.007) and disability reduction (OR = 2.08, 95% CI [1.23–3.52], p = 0.006).