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

  • Aaron CongerEmail author
  • Taylor Burnham
  • Rebecca A. Speckman
  • Dustin Randall
  • Raquel Reisinger
  • Quinn Tate
  • Ryan Spiker
  • Byron Schneider
  • Daniel M. Cushman
  • Zachary L. McCormick
Musculoskeletal Rehabilitation (B Schneider, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Musculoskeletal Rehabilitation



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.

Recent Findings

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.


Low back Pain Z-joint Zygapophyseal Neurotomy Imaging 


Compliance with Ethical Standards

Conflict of Interest

Zachary McCormick reports serving on the Board of Directors of the Spine Intervention Society. Ryan Spiker reports relationships with DePuy, Johnson&Johnson Company, and Synthes; and personal feeds from K2M, Nexus and NEXXT outside the submitted work. Aaron Conger, Taylor Burnham, Rebecca Speckman, Dustin Randall, Raquel Reisinger, Quinn Tate, Bryon Schneider, and Daniel Cushman declare no conflicts of interest relevant to this manuscript.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019
corrected publication 2019

Authors and Affiliations

  • Aaron Conger
    • 1
    Email author
  • Taylor Burnham
    • 1
  • Rebecca A. Speckman
    • 1
    • 2
  • Dustin Randall
    • 3
  • Raquel Reisinger
    • 1
  • Quinn Tate
    • 1
  • Ryan Spiker
    • 4
  • Byron Schneider
    • 5
  • Daniel M. Cushman
    • 1
  • Zachary L. McCormick
    • 1
  1. 1.Division of Physical Medicine and RehabilitationUniversity of UtahSalt Lake CityUSA
  2. 2.Department of Veterans Affairs Salt Lake City Health Care SystemSalt Lake CityUSA
  3. 3.Oakland University William Beaumont School of MedicineRochesterUSA
  4. 4.Department of OrthopaedicsUniversity of UtahSalt Lake CityUSA
  5. 5.Department of Physical Medicine and RehabilitationVanderbilt UniversityNashvilleUSA

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