Intraosseous Basivertebral Nerve Ablation for Vertebrogenic Pain

Vertebral endplates (VEP) are increasingly recognized as a source of chronic low back pain (CLBP) known as vertebrogenic back pain. The VEP is innervated by the basivertebral nerve (BVN) which is a target for intraosseous-radiofrequency ablation (RFA). Two multicenter, randomized, controlled trials have, respectively, demonstrated efficacy and effectiveness of this procedure for patients with CLBP and Modic type 1 or 2 changes on MRI. In the INTRACEPT trial, 77.2% of patients who underwent BVN ablation demonstrated a clinically significant ≥15-point improvement in Oswestry Disability Index (ODI) and 79.3% had a clinically significant ≥2-cm improvement in pain Visual Analog Scale (VAS) at 2 years. Several cohort studies have shown similar improvements in pain and function demonstrating reproducibility, and long-term follow-up analysis has revealed sustained improvement at more than 5 years suggesting durability. This procedure is typically completed using a unilateral, transpedicular delivery system for thermal RFA of the BVN. It is a minimally invasive procedure that is safely performed by physicians trained in multiple disciplines including surgical and non-surgical fields. The procedure has been available in the USA for patients since 2018 and appears to have a favorable long-term safety profile.