Vertebrogenic pain is a distinct type of chronic low back pain (CLBP) caused by damage to the vertebral endplates, which is the interface between the disc and the vertebral body. Disc degeneration, and the wear and tear that occurs with everyday living, produces stresses on the endplates that damage them, leading to inflammation and vertebrogenic low back pain.
Separating each vertebra and spinal disc is a thin layer of cartilage called the vertebral endplate. It is small—between 0.1 and 2 millimeters thick—yet it’s packed with nerves. Vertebral endplates are much more nerve-dense than spinal discs, which means they are more sensitive to pain. Vertebral endplate nerve dysfunction is when the endplate and the nerves within it become compressed, causing a great deal of pain. The compression is a natural side effect of years of wear and tear, and becomes more common in older patients or those who have placed a lot of stress on their back (athletes, military, construction workers, etc).
Vertebral endplate nerve dysfunction is often mistaken for degenerative disc disease or a multitude of othe
familiar with vertebral endplate nerve dysfunction, it’s easy to miss the signs on imaging studies.
Vertebrogenic back pain is often described by the patients as pain in the middle of their low back that is made worse by physical activity, prolonged sitting, bending forward, or with bending and lifting. The pain may radiate into the buttock or hip region, but generally does not radiate below the knees.
An MRI can be used to help determine a patient’s true cause of chronic back pain. If the pain is due to vertebral endplate nerve dysfunction, the MRI will show something called Modic changes within the bones of the spine. There are three distinct types of Modic changes:
Type 1: Bone marrow becomes inflamed and swells.
Type 2: Bone marrow turns to fatty tissue due to reduced blood flow.
Type 3: Bone marrow becomes sclerotic with thickening of the endplates.
If a patient has chronic low back pain lasting 12 weeks or more, and has either type 1 or 2 Modic changes, then they likely have vertebral endplate nerve dysfunction. Type 1 and 2 Modic changes indicate vertebral endplate nerve dysfunction that is amenable to the Intracept basivertebral nerve ablation procedure.
The Intracept basivertebral nerve ablation procedure is a minimally invasive treatment during which radiofrequency energy is used to destroy the nerve within the vertebral endplate that is transmitting pain signals to the brain.
If you suffer from lower back pain, you should be assessed to detect whether the cause could be vetebrogenic.
You can also be assessed for vertebrogenic lower back pain if you are just seeking treatment for your low back pain, and do not yet have a diagnosis. If your back pain has persisted for six months or longer, and has not responded to conservative therapies, you may want to consider getting a second opinion from a physician specially trained in vertebral endplate nerve dysfunction. We can see patients with back pain in our Sun City Center or Bradenton medical offices, and usually can schedule an appointment within a few days.
On the day of your procedure, you will arrive at the surgery center or hospital about 1 to 2 hours before the start of your scheduled treatment. This is to allow time to complete required paperwork and to prepare you for the procedure (change into a surgical gown, place an IV, meet with your anesthesia team, etc). The Intracept basivertebral nerve ablation is a minimally invasive, implant-free procedure. Once you are taken back to the operating room, a trained anesthesia team member will sedate you. Next, the surgeon will access the target area through two or more small (approximately 0.5 cm) incisions in the back. We then position a heat probe on the targeted nerve and use radiofrequency energy to destroy the nerve ending. The energy destroys only a tiny portion of the nerve that transmits pain signals to the brain. This is done at all affected levels.
We perform this procedure at an outpatient surgery center or in the outpatient surgery department of the hospital. The procedure takes about 60 to 90 minutes, with patients at the facility for 3 to 4 hours from check-in to check-out.
How long is the recovery period after the Intracept Basivertebral Nerve Ablation procedure?
Patients are able to return home within a few hours after they have the procedure. Most patients will experience immediate relief from their lower back pain. Some patients, however, may initially experience increased pain due to the procedure for about one to two weeks. You should take it easy the day of the procedure, but you usually can return to work and regular activity as soon as the day after having the Intracept procedure.
The basivertebral nerve does not regenerate like other nerves in the body, so it does not grow back. This means the relief can be very long-lasting, and there is rarely a need for any repeat procedures. In fact, most patients’ pain continues to improve over time with the majority reporting 75% to 100% pain reduction even five years after the procedure.