What is the role of CT scanning in the workup of lumbosacral facet syndrome?

Updated: Nov 19, 2018
  • Author: Gerard A Malanga, MD; Chief Editor: Craig C Young, MD  more...
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Answer

Generally, CT scanning is not necessary unless other bony pathology (eg, fracture) must be excluded.

A CT scan of the lumbosacral spine provides excellent anatomic imaging of the osseous structures of the spine, especially to rule out fractures or arthritic changes. Single-photon emission CT (SPECT) images may offer better resolution if spondylolysis is suggested.

With Z-joint pathology, one may find arthritic changes in the Z-joints and degenerative disc disease; however, Z-joint pathology is also frequently seen in asymptomatic patients, and, therefore, abnormal findings on a CT scan are not diagnostic.

Despite the excellent imaging of the bony anatomy of the Z-joint, CT scans are not useful for the diagnosis of the Z-joint as a pain generator. For example, Schwarzer et al found no correlation between Z-joint pathology on a CT scan and those patients who responded to diagnostic Z-joint blocks. [7] Therefore, the correlation of an abnormal Z-joint anatomy as observed on CT scans with true Z-joint–mediated pain is poor.


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