Clinical Diagnostic Tests versus Medial Branch Blocks for Adults with Persisting Cervical Zygapophyseal Joint Pain: A Systematic Review and Meta-Analysis

Abstract

A systematic review and meta-analysis were performed to identify clinical tests for diagnosing cervical zygapophyseal joint pain (CZP) and to determine their diagnostic accuracy. A search strategy was carried out to find relevant evidence published in CINAHL, Embase, MEDLINE, and PEDro from 1980 to January 1, 2015, pertaining to the clinical diagnosis of CZP. Quality assessment was completed using the Quality Assessment of Diagnostic Accuracy Studies-2. Results were analyzed to pool sensitivity and specificity and clarify diagnostic value. Seven articles (=463) were included for data synthesis and review. Intersegmental mobility tests were found to have the highest diagnostic accuracy, with pooled sensitivity of 0.91 (95% CI: 0.85, 0.94) and specificity of 0.74 (95% CI: 0.65, 0.81). The pooled sensitivity for mechanical sensitivity (palpation) was 0.88 (95% CI: 0.78, 0.95), and specificity was 0.61 (95% CI: 0.50, 0.71). Limited studies are available that discuss the clinical diagnosis of CZP, and significant heterogeneity is present in the available data. In this review, intersegmental mobility tests were found to be the most accurate. Clustering of tests, agreement on a reference standard, and further exploration of CZP referral patterns are recommended.

The Role of Diagnostic Injections in Spinal Disorders: A Narrative Review

“…In a 2018 meta-analysis of seven studies ( n = 463), Usunier et al found that intersegmental instability tests along with mechanical palpation have a relatively high diagnostic specificity (0.91 and 0.88, respectively) and sensitivity (0.74 and 0.61, respectively). However, the authors admit these findings were highly dependent on individual clinician experience and skill, impairing generalizability [ 13 ]. In an even larger systematic review performed by Maas et al, 129 different combinations of patient history and physical examination were evaluated, but failed to find conclusive evidence to support their diagnostic accuracy in facet arthropathy, demonstrating the importance of additional diagnostic techniques [ 14 ].…”