Ablation of the Basivertebral Nerve for the Treatment of Back Pain: A Pilot Clinical Study

Heggeness, Michael H.; Becker, Stephan; Hadjipavlou, Alexander; Danielson, Guy O.; Calodney, Aaron; Belza, Mark; Carl, Allen L.; Gordon, Charles

doi:10.1016/j.spinee.2011.08.166

Cited by 4 publications

(7 citation statements)

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“…The Modic change caused by disc degenerative processes involving damage and microfractures to the vertebral endplates results in the development of edema and inflammation of the adjacent vertebrae [ 5 , 11 ]. Factors associated with endplate damage following degenerative disc disease, ingrowth of new vessels, and collection of inflammatory agents may be important characteristics in the generation of pain [ 5 , 6 , 11 , 16 ]. In the normal state, bony endplates have a rich supply of small free nerve endings; degeneration and inflammation will likely trigger the inflammatory pain [ 13 ] (Figures 3 and 4 ).…”

Section: Discussionmentioning

confidence: 99%

“…Modic change is associated with chronic back pain [ 8 ]. While previous studies concluded that, among Modic changes, type 1 changes are the strongest and most crucial element in the disc degenerative process in relation to LBP, they also demonstrated that DDD with Modic changes was much more frequently associated with clinical symptoms [ 6 , 11 , 16 ]. Our patients also had mainly Modic type 1 changes, but some patients with Modic type 2 changes were also symptomatic in provocative discography; so they were also treated with TEBLA.…”

Section: Discussionmentioning

confidence: 99%

“…Basivertebral nerve sensitization causes CLBP. Substance P, a peptide neurotransmitter of the tachykinin family, is found within the basivertebral nerve, and there is very strong evidence that this nerve has the potential for transmitting pain signals [ 16 , 18 – 20 ]. Ablation of this nerve was our target.…”

Section: Discussionmentioning

confidence: 99%

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Transforaminal Epiduroscopic Basivertebral Nerve Laser Ablation for Chronic Low Back Pain Associated with Modic Changes: A Preliminary Open-Label Study

Kim

Adsul

Yudoyono

et al. 2018

Pain Research and Management

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Background Chronic low back pain (CLBP) arising from degenerative disc disease continues to be a challenging clinical and diagnostic problem whether treated with nonsurgical, pain intervention, or motion-preserving stabilization and arthrodesis. Methods Fourteen patients with CLBP, greater than 6 months, unresponsive to at least 4 months of conservative care were enrolled. All patients were treated successfully following screening using MRI findings of Modic type I or II changes and positive confirmatory provocative discography to determine the affected levels. All patients underwent ablation of the basivertebral nerve (BVN) using 1414 nm Nd:YAG laser-assisted energy guided in a transforaminal epiduroscopic approach. Macnab's criteria and visual analog scale (VAS) score were collected retrospectively at each follow-up interval. Results The mean age was 46 ± 9.95 years. The mean symptoms duration was 21.21 ± 21.87 months. The mean follow-up was 15.3 ± 2.67 months. The preoperative VAS score of 7.79 ± 0.97 changed to 1.92 ± 1.38, postoperatively (P < 0.01). As per Macnab's criteria, seven patients (50%) had excellent, six patients (42.85%) had good, and one patient (7.14%) had fair outcomes. Conclusion The transforaminal epiduroscopic basivertebral nerve laser ablation (TEBLA) appears to be a promising option in carefully selected patients with CLBP associated with the Modic changes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Transforaminal Epiduroscopic Basivertebral Nerve Laser Ablation for Chronic Low Back Pain Associated with Modic Changes: A Preliminary Open-Label Study

Kim

Adsul

Yudoyono

et al. 2018

Pain Research and Management

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“…The trocar is removed and exchanged for a curved cannula to create a channel to the predetermined position of the trunk of the basivertebral nerve near the centre of the vertebral body. Finally a radiofrequency probe is passed through the cannula and activated create a 1cm spherical lesion within the vertebral body (85˚C for 15 min) [22] [23] [24] [25]. This procedure has been assessed in multiple published trials over the past few years with positive outcomes, however the data has not been collated to fully assess the efficacy of this treatment in chronic low back pain.…”

Section: Introductionmentioning

confidence: 99%

Intraosseous Radiofrequency Ablation of the Basivertebral Nerve in Chronic Low Back Pain: A Meta-Analysis

Loan¹,

Kieser²

2021

OJRad

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Purpose: To review the literature on the value of basivertebral nerve ablation in the treatment of chronic low back pain. Materials and Method: A systematic review and meta-analysis of the English literature to March 2020 was undertaken. The inclusion criteria were patients with discogenic back pain of more than 3 months duration with modic type 1 or 2 change and successful disc block or discogram. Primary outcomes were VAS pain, ODI, EQ-5D and SF36 improvement. Secondary outcomes were complications. Results: 6 studies were included, all funded by the same company, but otherwise of low bias. All studies showed significant improvement in all scores over the first 3 months with evidence these would be maintained over the longer term. There was one reported compression fracture, but otherwise no significant adverse events. Conclusion: This study supports the conclusion that radiofrequency ablation of the basivertebral nerve is a safe and effective treatment for discogenic chronic low back pain.

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“…A more recent application of RF energy was developed in the last decade to ablate intraosseous basivertebral nerves, which innervate the vertebral endplates. Such nerves are involved in vertebrogenic pain, another source of LBP 20,21 . We investigated the efficacy and safety profile of the interventional pain management options for CLBP, with an emphasis on this newest approach to pain management.…”

mentioning

confidence: 99%

Pain Management Interventions for the Treatment of Chronic Low Back Pain

Mekhail

Eldabe

Templeton

et al. 2023

The Clinical Journal of Pain

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Objective: Determine the relative effectiveness and safety profiles of percutaneous and minimally invasive interventions for chronic low back pain.Methods: A systematic search was performed for randomized controlled trials published in the past 20 years reporting on radiofrequency ablation of the basivertebral, disk annulus and facet nerve structures, steroid injection of the disk, facet joint, and medial branch, biological therapies, and multifidus muscle stimulation. Outcomes evaluated included Visual Analog Scale (VAS) pain scores, Oswestry Disability Index (ODI) scores, quality of life (SF-36 and EQ-5D) scores, and serious adverse event (SAE) rates. Basivertebral nerve (BVN) ablation was chosen as the subject of comparison to all other therapies using a random-effects metaanalysis.Results: Twenty-seven studies were included. BVN ablation was found to provide statistically significant improvements in VAS and ODI scores for 6-, 12-and 24-month follow-up (P ≤ 0.05). Biological therapy and multifidus muscle stimulation were the only 2 treatments with both VAS and ODI outcomes not significantly different from BVN ablation at 6-, 12-, and 24-month follow-up. All outcomes found to be statistically significant represented inferior results to those of BVN ablation. Insufficient data precluded meaningful comparisons of SF-36 and EQ-5D scores. The SAE rates for all therapies and all reported time points were not significantly different from BVN ablation except for biological therapy and multifidus muscle stimulation at the 6-month follow-up.Conclusions: BVN ablation, biological therapy, and multifidus stimulation all provide significant, durable improvements in both pain and disability compared with other interventions, which provided only short-term pain relief. Studies on BVN ablation reported no SAEs, a significantly better result than for studies of biological therapy and multifidus stimulation.

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Ablation of the Basivertebral Nerve for the Treatment of Back Pain: A Pilot Clinical Study

Cited by 4 publications

References 0 publications

Transforaminal Epiduroscopic Basivertebral Nerve Laser Ablation for Chronic Low Back Pain Associated with Modic Changes: A Preliminary Open-Label Study

Transforaminal Epiduroscopic Basivertebral Nerve Laser Ablation for Chronic Low Back Pain Associated with Modic Changes: A Preliminary Open-Label Study

Intraosseous Radiofrequency Ablation of the Basivertebral Nerve in Chronic Low Back Pain: A Meta-Analysis

Pain Management Interventions for the Treatment of Chronic Low Back Pain

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