The results of this review demonstrate that tests do exist that change the probability of the disc or SIJ ( but not the facet joint ) as the source of low back pain .
Clinical practice guidelines state that the tissue source of low back pain can not be specified in the majority of patients .
However , there has been no systematic review of the accuracy of diagnostic tests used to identify the source of low back pain .
The aim of this systematic review was therefore to determine the diagnostic accuracy of tests available to clinicians to identify the disc , facet joint or sacroiliac joint ( SIJ ) as the source of low back pain .
Zygapophysial joint blocks in chronic low back pain: a test of Revel's model as a screening test
Background Only controlled blocks are capable of confirming the zygapophysial joints ( ZJ ) as the pain generator in LBP patients . However , previous workers have found that a cluster of clinical signs ( " Revel 's criteria ") , may be valuable in predicting the results of an initial screening ZJ block . It was suggested that these clinical findings are unsuitable for diagnosis , but may be of value in selecting patients for diagnostic blocks of the lumbar ZJ 's . To constitute evidence in favour of a clinical management strategy , these results need confirmation . This study evaluates the utility of ' Revel 's criteria ' as a screening tool for selection of chronic low back pain patients for controlled ZJ diagnostic blocks . Methods This study utilized a prospect i ve blinded concurrent reference st and ard related validity design . Consecutive chronic LBP patients completed pain drawings , psychosocial distress and disability question  naires  , received a clinical examination and lumbar zygapophysial blocks . Two reference st and ards were evaluated simultaneously : 1 . 75 % reduction of pain on a visual analogue scale ( replication of previous work ) , and 2 . abolition of the dominant or primary pain . Using " Revel 's criteria " as predictors , logistic regression analyses were used to test the model . Estimates of sensitivity , specificity , predictive values and likelihood ratios for selected variables were calculated for the two proposed clinical strategies . Results Earlier results were not replicated . Sensitivity of " Revel 's criteria " was low sensitivity ( < 17 % ) , and specificity high ( approximately 90 % ) . Absence of pain with cough or sneeze just reached significance ( p = 0.05 ) within one model . Conclusions " Revel 's criteria " are unsuitable as a clinical screening test to select chronic LBP patients for initial ZJ blocks . However , the criteria may have use in identifying a small subset ( 11 % ) of patients likely to respond to the initial block ( specificity 93 % )
The results of this review demonstrate that tests do exist that change the probability of the disc or SIJ ( but not the facet joint ) as the source of low back pain .
Clinical practice guidelines state that the tissue source of low back pain can not be specified in the majority of patients .
However , there has been no systematic review of the accuracy of diagnostic tests used to identify the source of low back pain .
The aim of this systematic review was therefore to determine the diagnostic accuracy of tests available to clinicians to identify the disc , facet joint or sacroiliac joint ( SIJ ) as the source of low back pain .