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Purpose <p>Facet joint pain is a common cause of mechanical low back pain. Single-photon emission computed tomography (SPECT/SPECT-CT) aids in identifying pain foci. Still, its role in guiding therapeutic decisions for facet joint interventions, such as medial branch blocks and intra-articular injections, and their associated clinical response remains uncertain. This study aims to assess the effectiveness of SPECT/SPECT-CT in guiding facet interventions for low back pain.</p> Methods <p>A systematic review was conducted in accordance with PRISMA guidelines, searching seven databases and two clinical trial registries. Studies comparing outcomes between patients undergoing facet joint interventions guided by positive SPECT/SPECT-CT findings and those with negative imaging results, alternative imaging modalities, or physical examination were included. Pain intensity, functionality, and quality of life were assessed. The ROBINS-I tool was used to evaluate the risk of bias. Data were synthesized in tables, and a meta-analysis was performed.</p> Results <p>Of 2,622 articles screened, six cohort studies met the inclusion criteria, including four that used intra-articular injections, with a total of 308 patients. SPECT alone showed a significant pooled effect favoring pain relief after facet interventions (RR 2.06, 95% CI 1.54–2.75; I² = 3%), while SPECT-CT showed no significant effect (RR 0.93, 95% CI 0.59–1.49; I² = 74%). By intervention type, intra-articular injections guided by SPECT/SPECT-CT showed a significant effect (RR 1.71, 95% CI 1.18–2.46; I² = 61%), whereas medial branch blocks did not (RR 1.03, 95% CI 0.58–1.84; I² = 72%). Sensitivity analysis excluding one high-risk study confirmed the significant pooled effect (RR 1.67, 95% CI 1.12–2.48; I² = 0%).</p> Conclusion <p>SPECT alone may help predict outcomes for facet interventions, especially intra-articular injections, but evidence for SPECT-CT remains inconclusive. This should be interpreted with caution, given the current study limitations.</p>

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Effectiveness of single-photon emission computed tomography (SPECT/SPECT-CT) in predicting therapeutic response to facet interventions for facet joint-related low back pain: A systematic review and Meta-Analysis

  • 期刊论文

  • 发表日期：

    2025年8月12日

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  • Raul F. Vega-Alvear,
  • Santiago Fuentes-Tapias,
  • Alexandra Ramos-Márquez,
  • Antonia Cadavid,
  • Juan P. Navarro-Garcia de Llano,
  • Leonardo B. O. Brenner,
  • Raphael Bertani,
  • Edgar G. Ordóñez-Rubiano,
  • Juan F. Ramón,
  • Fernando Hakim,
  • Diego F. Gómez-Amarillo

摘要

Purpose

Facet joint pain is a common cause of mechanical low back pain. Single-photon emission computed tomography (SPECT/SPECT-CT) aids in identifying pain foci. Still, its role in guiding therapeutic decisions for facet joint interventions, such as medial branch blocks and intra-articular injections, and their associated clinical response remains uncertain. This study aims to assess the effectiveness of SPECT/SPECT-CT in guiding facet interventions for low back pain.

Methods

A systematic review was conducted in accordance with PRISMA guidelines, searching seven databases and two clinical trial registries. Studies comparing outcomes between patients undergoing facet joint interventions guided by positive SPECT/SPECT-CT findings and those with negative imaging results, alternative imaging modalities, or physical examination were included. Pain intensity, functionality, and quality of life were assessed. The ROBINS-I tool was used to evaluate the risk of bias. Data were synthesized in tables, and a meta-analysis was performed.

Results

Of 2,622 articles screened, six cohort studies met the inclusion criteria, including four that used intra-articular injections, with a total of 308 patients. SPECT alone showed a significant pooled effect favoring pain relief after facet interventions (RR 2.06, 95% CI 1.54–2.75; I² = 3%), while SPECT-CT showed no significant effect (RR 0.93, 95% CI 0.59–1.49; I² = 74%). By intervention type, intra-articular injections guided by SPECT/SPECT-CT showed a significant effect (RR 1.71, 95% CI 1.18–2.46; I² = 61%), whereas medial branch blocks did not (RR 1.03, 95% CI 0.58–1.84; I² = 72%). Sensitivity analysis excluding one high-risk study confirmed the significant pooled effect (RR 1.67, 95% CI 1.12–2.48; I² = 0%).

Conclusion

SPECT alone may help predict outcomes for facet interventions, especially intra-articular injections, but evidence for SPECT-CT remains inconclusive. This should be interpreted with caution, given the current study limitations.