Basivertebral Nerve Ablation

Chronic low back pain that does not respond to conservative care, facet ablations, or disc procedures can be challenging to treat. However, there is a new, minimally invasive, intraosseous nerve-ablating procedure that targets the basivertebral nerve of the superior and inferior vertebral endplate. This region serves as an interface between the vertebra and the disk.

A multicenter study of 225 patients randomized to treatment (147) or sham (78) interventions reported in the International Journal of Spine Surgery showed sustained clinical benefits on both the Oswestry Disability Index (ODI) and the Visual Analog Scale (VAS) as well as high responder rates at two years following treatment. Mean percent improvements in ODI and VAS compared to baseline were 54% and 53%, respectively, in patients who had the procedure.

Suboptimal success rates with conventional treatments for CLBP have led medical researchers to probe whether they have been missing a pain generator. Anatomic studies over the past several years have shown the vertebral endplates to be a significant source of CLBP. These patients typically will have changes on MRI in the region above or below the endplate called Modic changes.

The procedure is performed similarly to vertebroplasty or kyphoplasty, where a trochar enters the vertebral body into the center of the body, where the basivertebral nerve is located. Then a radiofrequency probe is passed through the trochar into the bone. Radiofrequency-mediated heat is then used for 120 seconds in 2 different planes using a venom trochar to allow for a large area ablation. Patients typically get pain relief 1-2 weeks post-procedure.