Single-photon emission computed tomography has been proven to detect more abnormalities than planar bone scintigraphy in patients with low back pain (LBP). Both 180° and 360° acquisitions were performed in 24 patients with LBP to determine whether the shorter 180° posterior SPECT is as accurate for abnormality detection as 360° acquisition. The vertebral bodies and posterior elements of 193 vertebrae were scored on a five-point score (1 = normal, 5 = abnormal), independently by three experienced physicians, on three separate reconstructed image sets: standard, filtered, back projection 360° acquisition, distance-weighted 360° acquisition, and standard, filtered, back projection 180° acquisition. With one exception, no statistically significant difference in score was found between 180° and 360° images. For one observer, the mean score of the posterior elements was higher on 180° compared to 360° standard images. These results indicate that 180° acquisition SPECT may be used for abnormality detection in patients with LBP.