Basivertebral Nerve Ablation for the Treatment of Vertebrogenic Pain

Abstract

Chronic low back pain affects a significant portion of patients worldwide and is a major contributor to patient disability; however, it is a difficult problem to diagnose and treat. The prevailing model of chronic low back pain has presumed to follow a discogenic model, but recent studies have shown a vertebrogenic model that involves the basivertebral nerve (BVN). Radiofrequency ablation of the BVN has emerged as a possible nonsurgical therapy for vertebrogenic low back pain. The objective of this manuscript is to provide a comprehensive review of vertebrogenic pain diagnosis and our current understanding of BVN ablation as treatment.

Developments in Minimally Invasive Surgical Options for Vertebral Pain: Basivertebral Nerve Ablation – A Narrative Review

“…There is no radicular expression, lower extremity weakness, nor sensory deficits and the neural tension sign and pain tends to be worse with spinal flexion, sitting, standing and with general physical activity, in contrast to extension. 17 , 26 , 28 , 29 To provide additional insight on vertebrogenic pain symptomatology responsive to BVNA, aggregated data from over 320 clinical trial reported by Relievant Medsystems, patients revealed that 70% of patients indicated their pain location as midline on body diagrams and less than 6% reported pain below the mid-gluteal region.…”

“…Per the foundational studies discussed at length moving forward in this manuscript, BVN RFA may be successfully utilized in patients with axial chronic low back pain of vertebral etiology of at least 6-months duration, who have failed conservative treatment for at least 6-months, have radiological evidence of MCs type 1 or type 2 on MRI between the L3-S1 spinal segments while also fulfilling a number of other criteria discussed at length later, namely the absence of radicular symptoms, no history of previous lumbar surgery, and no osteoporosis, etc. 1 , 28 , 29 …”

“…While no formalized evidentiary analysis was performed, our narrative review agrees with the conclusion of Conger et al that there exists moderate-quality evidence that BVN RFA is an effective intervention for reduction of disability and improvement in function, as measured by the ODI at short- and long-term follow-up for patients with vertebral pain. 6–10 , 12 , 13 , 28 , 30 , 31 , 33 .…”

“…AEs were defined as procedure-related: incisional pain, urinary retention, meralgia paresthetica, new-onset back pain, or new-onset radiculopathy or paresthesia. 6 , 9 , 13 , 28 , 29 Lorio et al published a guideline regarding BVN RFA for vertebrogenic pain compiling multiple studies and suggested that BVN RFA for a specific subset of vertebrogenic pain patients with MCs on MRI has an excellent safety profile, when compared to other interventions. 1 A systematic review of BVN ablation agreed.…”

“…Per the foundational studies discussed at length moving forward in this manuscript, BVN RFA may be successfully utilized in patients with axial chronic low back pain of vertebral etiology of at least 6-months duration, who have failed conservative treatment for at least 6-months, have radiological evidence of MCs type 1 or type 2 on MRI between the L3-S1 spinal segments while also fulfilling a number of other criteria discussed at length later, namely the absence of radicular symptoms, no history of previous lumbar surgery, and no osteoporosis, etc. 1,28,29 The majority of studies reviewed reported functional outcomes with the Oswestry Disability Index (ODI) and pain assessment utilizing the visual analog scale (VAS). Quality of life measurements were reported utilizing the short form 36 (SF-36) and/or the EQ-5D-5L questionnaire, patient satisfaction was analyzed utilizing the MacNab's criteria, and opioid utilization was also reported as an outcome measurement.…”