title: Correlation of (99m) Tc-DPD SPECT/CT Scan Findings and Diagnostic Blockades of Lumbar Medial Branches in Patients with Unspecific Low Back Pain in a Randomized-Controlled Trial.
abstract: OBJECTIVE
  Zygapophyseal joints are the origin of pain in up to 30% of those with unspecific chronic low back pain. Until recently, no reliable clinical tests have been found to identify the patients who would benefit from denervation of the zygapophyseal joints by medial branch blockades.
  
  
  METHODS
  We performed a prospective randomized placebo-controlled trial to evaluate the value of high-resolution single-photon emission computed tomography (SPECT)/computed tomography (CT) of the lumbar spine prior to any diagnostic infiltration of the medial branches.
  
  
  METHODS
  Patients with suspected zygapophyseal joint-related pain were included in the study. After obtaining a SPECT/CT scan of the lumbar spine a set of infiltrations of the medial branches was done with local anesthetics and placebo on different days. Patients and anesthetists were blinded to the results of SPECT/CT and to the infiltrated agents.
  
  
  RESULTS
  In a total of 29 study patients, 7 had positive and 22 negative infiltration tests, and 9 had positive and 20 negative SPECT/CT findings. Sensitivity of SPECT/CT for a positive response after diagnostic infiltration was 0.57 (95% confidence interval [CI] 0.18-0.90); specificity was 0.77 (CI 95% 0.55-0.92); odds ratio was 4.53 (CI 95% 0.75-27.40); and diagnostic accuracy was 0.72.
  
  
  CONCLUSIONS
  Compared with diagnostic infiltrations SPECT/CT scans showed only a moderate sensitivity and specificity and, therefore, may not be recommended as a first line diagnostic tool prior to diagnostic infiltrations.
authors.affiliation: Departments of Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, CH-4031, Basel, Switzerland.
authors.forename: David
authors.initials: D
authors.lastname: Freiermuth
authors.affiliation: Radiology and Nuclear Medicine, University Hospital Basel, CH-4031, Basel, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Kretzschmar
authors.affiliation: Department of Radiology and Nuclear Medicine, Cantonal Hospital Baselland, Switzerland.
authors.forename: Denis
authors.initials: D
authors.lastname: Bilecen
authors.affiliation: Orthopedic Department, University Hospital Basel, CH-4031, Basel, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Schaeren
authors.affiliation: Radiology and Nuclear Medicine, University Hospital Basel, CH-4031, Basel, Switzerland.
authors.forename: Augustinus Ludwig
authors.initials: AL
authors.lastname: Jacob
authors.affiliation: Departments of Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, CH-4031, Basel, Switzerland.
authors.forename: Armin
authors.initials: A
authors.lastname: Aeschbach
authors.affiliation: Departments of Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, CH-4031, Basel, Switzerland.
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Ruppen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003714:Denervation / Q000379:methods*; D004164:Diphosphonates; D005260:Female; D006801:Humans; D007230:Infant, Low Birth Weight; D017116:Low Back Pain / Q000175:diagnosis* / Q000628:therapy*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging* / Q000294:innervation; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D009407:Nerve Block; D015609:Organotechnetium Compounds; D010147:Pain Measurement; D015990:Placebo Effect; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D013223:Statistics as Topic; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D021801:Zygapophyseal Joint / Q000000981:diagnostic imaging* / Q000294:innervation / Q000601:surgery*
chemical_list: D004164:Diphosphonates; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C033905:technetium Tc 99m 1,1-diphosphonopropane-2,3-dicarboxylic acid
keywords: Lumbar Medial Branch Blockade; SPECT/CT Scan; Unspecific Low Back Pain