Purpose <p>SPECT-CT is a hybrid imaging modality which has become very well established in the diagnosis of inflammatory, vascular and malignant processes affecting the spine. However, little evidence exists on its application with degenerative pathologies. Thus, we have conducted a systematic review on the use of SPECT- CT in the diagnosis of degenerative facet joint arthropathy.</p> Methods <p>824 adult patients across 10 studies conducted over the last nine years (2012–2020), with a mean age of 51.8 years old. All studies excluded patients with malignancy, infection or inflammatory etiologies or those related to acute trauma. Only degenerative pathologies of the lumbar spine in an adult population were included. A systematic review of the literature available on the topic was conducted using the PubMed, Cochrane, Medline and Embase online databases of journal articles.</p> Results <p>Five studies focused on SPECT-CT alone/versus CT. Two focused on SPECT-CT vs. MRI, and three focused on SPECT-CT guided facet joint injections. Of these 10 studies, seven concluded with results supporting SPECT CT’s use, two reported discordance between SPECT-CT findings with those diagnosed from clinical examination / MRI scans, and one study’s conclusions were equivocal.</p> Conclusion <p>SPECT-CT shows promise as an imaging adjunct in assisting with the diagnosis and subsequent treatment of degenerative facet joint arthropathies. In patients whose MRI scans reveal multiple potential pain generators, SPECT-CT could help differentiate between clinically significant sources of pain and may even serve a purpose in guiding facet joint injections in patients with inconclusive MRI/CT scans.</p>