BACKGROUND: Chronic neck or back pain is a common clinical problem. The most likely cause is degenerative change, whereas other causes are relatively rare. There is increasing evidence on using hybrid single-photon emission computed tomography (SPECT) to identify the pain generator in spine degeneration. This systematic review explores the diagnostic and therapeutic evidence on chronic neck or back pain examined by SPECT. METHODS: This review is reported in accordance with the PRISMA guidelines. In October 2022, we searched the following sources: MEDLINE, Embase, CINAHL, SCOPUS, and 3 other sources. Titles and abstracts were screened and classified into diagnostic studies, facet block studies, and surgical studies. We synthesized the results narratively. RESULTS: The search yielded 2347 records. We identified 10 diagnostic studies comparing SPECT or SPECT/computed tomography (CT) with magnetic resonance imaging, CT, scintigraphy, or clinical examination. Furthermore, we found 8 studies comparing the effect of facet block intervention in SPECT-positive and SPECT-negative patients with cervicogenic headache, neck pain, and lower back pain. Five surgical studies describing the effect of fusion for facet arthropathy in the craniocervical junction, subaxial cervical spine, or the lumbar spine were identified. CONCLUSIONS: According to the available literature, a positive finding on SPECT in facet arthropathy is associated with a significantly higher facet blockade effect. Surgical treatment of positive findings has a good effect, but this has not been confirmed by controlled studies. SPECT/CT might therefore be a useful method in the evaluation of patients with neck or back pain, especially in cases of unclear findings or multiple degenerative changes.

Department of Neurosurgery and Neurooncology 1st Faculty of Medicine Charles University and Military University Hospital Prague Prague Czech Republic

Department of Neurosurgery The Walton Centre NHS Foundation Trust Liverpool United Kingdom

Department of Nuclear Medicine and Endocrinology 2nd Faculty of Medicine Charles University and Military University Hospital Prague Prague Czech Republic

Department of Spinal Surgery 1st Faculty of Medicine Charles University and University Hospital Motol Prague Czech Republic

Institute of Health Information and Statistics of the Czech Republic Prague Czech Republic

Institute of Translational Medicine University of Liverpool Liverpool United Kingdom

The Czech National Centre for Evidence Based Healthcare and Knowledge Translation Institute of Biostatistics and Analyses Faculty of Medicine Masaryk University Brno Czech Republic

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$a Varga, Michal $u Department of Spinal Surgery, First Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic. Electronic address: michalvarga.spondylo@gmail.com

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$a Role of Single-Photon Emission Computed Tomography Imaging in the Diagnosis and Treatment of Chronic Neck or Back Pain Caused by Spinal Degeneration: A Systematic Review / $c M. Varga, L. Kantorová, A. Langaufová, J. Štulík, L. Lančová, N. Srikandarajah, R. Kaiser

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$a BACKGROUND: Chronic neck or back pain is a common clinical problem. The most likely cause is degenerative change, whereas other causes are relatively rare. There is increasing evidence on using hybrid single-photon emission computed tomography (SPECT) to identify the pain generator in spine degeneration. This systematic review explores the diagnostic and therapeutic evidence on chronic neck or back pain examined by SPECT. METHODS: This review is reported in accordance with the PRISMA guidelines. In October 2022, we searched the following sources: MEDLINE, Embase, CINAHL, SCOPUS, and 3 other sources. Titles and abstracts were screened and classified into diagnostic studies, facet block studies, and surgical studies. We synthesized the results narratively. RESULTS: The search yielded 2347 records. We identified 10 diagnostic studies comparing SPECT or SPECT/computed tomography (CT) with magnetic resonance imaging, CT, scintigraphy, or clinical examination. Furthermore, we found 8 studies comparing the effect of facet block intervention in SPECT-positive and SPECT-negative patients with cervicogenic headache, neck pain, and lower back pain. Five surgical studies describing the effect of fusion for facet arthropathy in the craniocervical junction, subaxial cervical spine, or the lumbar spine were identified. CONCLUSIONS: According to the available literature, a positive finding on SPECT in facet arthropathy is associated with a significantly higher facet blockade effect. Surgical treatment of positive findings has a good effect, but this has not been confirmed by controlled studies. SPECT/CT might therefore be a useful method in the evaluation of patients with neck or back pain, especially in cases of unclear findings or multiple degenerative changes.

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$a Kantorová, Lucia $u The Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech CEBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic; Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic

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$a Langaufová, Alena $u The Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech CEBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic; Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic

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$a Štulík, Jan $u Department of Spinal Surgery, First Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic

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$a Lančová, Lucie $u Department of Nuclear Medicine and Endocrinology, Second Faculty of Medicine, Charles University and Military University Hospital Prague, Prague, Czech Republic

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$a Srikandarajah, Nisaharan $u Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom; Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom

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$a Kaiser, Radek $u Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital Prague, Prague, Czech Republic

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