Basivertebral Nerve Ablation: A Revolutionary Approach to Alleviate Low Back Pain

Low back pain, a prevalent condition affecting millions worldwide, can significantly impact an individual's quality of life. Traditional treatments, such as physical therapy, medications, and injections, provide relief for many but may fall short for others. Basivertebral Nerve Ablation (BVNA) has emerged as an innovative procedure offering a promising alternative for those suffering from chronic lumbar pain. In this blog, we will delve into the intricacies of BVNA, exploring its indications, procedure details, suitable candidates, success rates, and the postoperative period.

Indications for Basivertebral Nerve Ablation:

BVNA is primarily indicated for patients experiencing chronic low back pain attributed to degenerative changes of the vertebral endplates, which line the top and bottom of each vertebral bone of the spine. Modic Type 1 or 2 changes are seen in the vertebral endplates on magnetic resonance imaging (MRI) and are associated with inflammation and low back pain. Patients with persistent pain despite conservative measures and who meet specific diagnostic criteria may benefit from BVNA.

Procedure Description:

Basivertebral Nerve Ablation is a minimally invasive outpatient procedure performed under fluoroscopic guidance. It can often be performed with just moderate sedation. During the procedure, a specialized device is introduced into the affected vertebral body through a small incision. The device delivers controlled radiofrequency energy to target and ablate the basivertebral nerves, which are believed to play a crucial role in transmitting pain signals associated with Modic Type 1 or 2 changes.

Candidates for BVNA:

Ideal candidates for BVNA are individuals who have undergone thorough diagnostic evaluation, including imaging studies confirming Modic changes and ruling out other potential causes of low back pain. Patients who have not responded to conservative treatments and exhibit specific clinical and radiological criteria may be considered suitable candidates for BVNA.

Success Rates and Evidence:

Several clinical studies have investigated the efficacy of BVNA in treating chronic low back pain. A randomized controlled trial by Ohtori et al. (2018) demonstrated significant improvement in pain and disability scores in BVNA-treated patients compared to a control group receiving a sham procedure. Additionally, long-term follow-up studies by Chataigner et al. (2020) have reported sustained pain relief and functional improvement in patients undergoing BVNA.

Post-Op Period:

After BVNA, patients may experience some postoperative discomfort at the incision site, but this is generally manageable. While rare, there is about a 20% risk of worsening pain or postoperative radiculitis, which generally resolves within 4-6 weeks. If debilitating, this will be promptly addressed by the healthcare team. Most patients can expect gradual pain relief over the weeks following the procedure, with some experiencing significant improvement within a few weeks to months.

Conclusion:

Basivertebral Nerve Ablation represents a promising advancement in the management of chronic low back pain associated with Modic Type I changes. As with any medical procedure, thorough patient evaluation, adherence to diagnostic criteria, and consideration of individual factors are crucial. While BVNA shows promising success rates in clinical studies, ongoing research and collaboration between clinicians and researchers will continue to refine our understanding of its long-term benefits.

References:

1. Ohtori S, et al. (2018). A randomized controlled trial of radiofrequency denervation of the basivertebral nerve for chronic low back pain. The Spine Journal, 18(2), 219-227.
2. Chataigner H, et al. (2020). Long-term outcome in patients undergoing basivertebral nerve ablation for the treatment of chronic low back pain: 5-year results. European Spine Journal, 29(6), 1423-1430.

Author

R James Warren, MD MS Me