The Accuracy of SPECT/CT for Diagnosing Lumbar Zygapophyseal Joint Pain: a Systematic Review

Abstract

To determine the accuracy of Tc-99m methylenediphosphonate single photon emission computed tomography (SPECT/CT) for the diagnosis of lumbar zygapophyseal joint-related pain with dual medial branch block (> 70% threshold) as the reference standard. To date, the accuracy of SPECT/CT for the diagnosis of lumbar zygapophyseal joint pain has not been systematically reviewed. One study met inclusion criteria. A prospective cohort study of 35 patients reported a prevalence of 24% (95% CI 9.0–40.0%) using dual medial branch blocks (MBBs) as the means of diagnosis and found that SPECT/CT had a sensitivity of 0.57 (95% CI 0.18–0.90), specificity of 0.77 (95% CI 0.55–0.92), LR+ of 2.51 (95% CI 0.92–6.85), and LR− of 0.55 (95% CI 0.23–1.34). According to OCEBM 2011 guidelines, the evidence is rated as level 3. More research is needed to determine the accuracy of SPECT/CT for the diagnosis of Z-joint pain, as technological improvement and interpretation could potentially improve overall diagnostic accuracy and reduce associated costs.