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.

Abstract

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. 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. 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%). 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.