A First Estimate of the Annual Prevalence of Basivertebral Nerve Ablation Candidates in a Spine Clinic

Abstract

Emerging literature purports the use of basivertebral nerve ablation (BVNA) for a specific cohort of patients with chronic low back pain and Type 1 or Type 2 Modic changes from vertebral levels L3-S1. The early literature warrants further evaluation. Studies establishing the efficacy of BVNA use highly selective patient criteria. The population which fulfills these criteria in our practice is small. Our study suggests it is perhaps 3% (11/338, 95% CI 1–5%).

The interrater reliability of Modic changes among a potential basivertebral nerve ablation population: Why AC1 may be preferred to kappa

“…For therapeutic decision making, both are critical. Our study may serve as a sentinel warning that the agreement regarding Modic changes may have profound clinical implications for BVNA patient selection and thus outcomes, as the identification and characterization of Modic changes is the only radiographic crux upon which BVNA is indicated 38 …”

“…Patient records were then excluded if no lumbar MRI was ordered or was viewable within the time frame of the study. The final cohort included those patients who met the relevant diagnosis codes, did not satisfy any of the exclusionary criteria found in Table 2, and included a lumbar MRI ordered or viewable within the study time frame that was available in the electronic database 38 …”

“…The final cohort included those patients who met the relevant diagnosis codes, did not satisfy any of the exclusionary criteria found in Table 2, and included a lumbar MRI ordered or viewable within the study time frame that was available in the electronic database. 38 A team of imaging reviewers was established with two boardcertified and fellowship trained neuroradiologists and two board- for standardization of categorization. Furthermore, reviewers were provided with a document of visual examples and written characterization instructions (Table 3).…”

“…For therapeutic decision making, both are critical. Our study may serve as a sentinel warning that the agreement regarding Modic changes may have profound clinical implications for BVNA patient selection and thus outcomes, as the identification and characterization of Modic changes is the only radiographic crux upon which BVNA is indicated 38. 9 | CONCLUSIONOur cohort of potential BVNA candidates reviewed by our two-board certified fellowship trained neuroradiologists and two board certified interventional spine fellowship trained physiatrists revealed a kappa value on the presence and characterization of modic changes (MC) as 0.51 (95% CI 0.37-0.67) and 0.52 (95% CI 0.37-0.65), respectively.The range of value for such agreement is from minimal to moderate.Using AC1 on the presence and characterization of MC as 0.51 (95% CI 0.36-0.66) and 0.75 (95% CI 0.66-0.83), respectively.…”