Non-Spinal Neuromodulation of the Lumbar Medial Branch Nerve for Chronic Axial Low Back Pain: A Narrative Review

Francio, Vinicius Tieppo; Westerhaus, Benjamin D.; Rupp, Adam; Sayed, Dawood

doi:10.3389/fpain.2022.835519

Cited by 6 publications

(3 citation statements)

References 45 publications

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“…The BVN is a recurrent sensory nerve in the vertebral body, supplying proprioceptive and nociceptive input to the vertebral endplates. It arises from the sinuvertebral nerve, a branch of the bilateral ventral rami of spinal nerves and passes through the basivertebral foramen anteriorly within the vertebral body 21 22. Ablating this nerve offers an effective strategy to interrupt pain signals and alleviate symptoms associated with this condition.…”

Section: Discussionmentioning

confidence: 99%

Basivertebral nerve ablation with concurrent lumbar laminotomy

Marcus,

Westerhaus,

Chernicki

et al. 2024

BMJ Case Rep

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Lumbar radiculopathy due to impingement of nerve roots from facet hypertrophy and/or disc herniation can often coincide with vertebrogenic low back pain. This is demonstrated on MRI with foraminal stenosis and Modic changes. We examine the potential of using a combination of basivertebral nerve ablation (BVNA) and lumbar laminotomy as an alternative to traditional spinal fusion in specific patient populations. This unique combination of surgical techniques has not been previously reported in the medical literature. We report a man in his late 30s with chronic low back pain and lumbar radiculopathy, treated with BVNA and concurrent laminotomy. The patient reported progressive improvements in his mobility and pain over the next 2 years. We discuss the advantages of using this technique for lumbar radiculopathy and Modic changes compared with conventional surgical modalities.

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Section: Discussionmentioning

confidence: 99%

Basivertebral nerve ablation with concurrent lumbar laminotomy

Marcus,

Westerhaus,

Chernicki

et al. 2024

BMJ Case Rep

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show abstract

“…Currently, there is one Food and Drug Administration (FDA) cleared procedural platform to ablate the BVN of the L3 through S1 vertebrae, indicated for patients with axial LBP greater than 6 months of duration who are refractory to conservative nonsurgical management and have evidence of type 1 and/or type 2 Modic changes of vertebral endplates on diagnostic images. 31 , 32 As of January 2022, two current procedural terminology (CPT) codes have been established to report the BVNA procedure, 64,628 (first two vertebral bodies) and 64,629 (each additional vertebral body). The diagnosis code that applies for this procedure is M54.51 (vertebrogenic low back pain/low back pain vertebral endplate pain).…”

Section: Evidence For Bvn Ablationmentioning

confidence: 99%

Best Practice Guidelines on the Diagnosis and Treatment of Vertebrogenic Pain with Basivertebral Nerve Ablation from the American Society of Pain and Neuroscience

Sayed¹,

Naidu²,

Patel³

et al. 2022

JPR

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Chronic low back pain is a worldwide leading cause of pain and disability. Degenerative disc disease has been the presumptive etiology in the majority of cases of chronic low back pain (CLBP). More recent study and treatments have discovered that the vertebral endplates play a large role in CLBP in a term defined as vertebrogenic back pain. As the vertebral endplates are highly innervated via the basivertebral nerve (BVN), this has resulted in a reliable target in treating patients suffering from vertebrogenic low back pain (VLBP). The application of BVN ablation for patients suffering from VLBP is still in its early stages of adoption and integration into spine care pathways. BVN ablation is grounded in a solid foundation of both pre-clinical and clinical evidence. With the emergence of this therapeutic option, the American Society of Pain and Neuroscience (ASPN) identified the need for formal evidence-based guidelines for the proper identification and selection of patients for BVN ablation in patients with VLBP. ASPN formed a multidisciplinary work group tasked to examine the available literature and form best practice guidelines on this subject. Based on the United States Preventative Task Force (USPSTF) criteria for grading evidence, gives BVN ablation Level A grade evidence with high certainty that the net benefit is substantial in appropriately selected individuals.

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“…Low back pain (LBP) remains the leading cause of disability worldwide with an astonishing economic impact due to its excessive prevalence, high recurrence rate, and variable treatment effectiveness resultant from diverse anatomical etiologies and complex symptoms. [1][2][3] Spinal cord stimulation (SCS) has been historically used for chronic low back pain (CLBP) for over 20 years, and its use continues to grow as therapeutic indications expand. [4][5][6] It is estimated that approximately 50,000 SCS devices are implanted each year in the United States with an increasingly steady growth rate of 8%-10% annually.…”

Section: Introductionmentioning

confidence: 99%

Variables associated with nonresponders to high‐frequency (10 kHz) spinal cord stimulation

Tieppo Francio,

Alm,

Leavitt

et al. 2023

Pain Practice

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IntroductionThe use of spinal cord stimulation (SCS) therapy to treat chronic pain continues to rise. Optimal patient selection remains one of the most important factors for SCS success. However, despite increased utilization and the existence of general indications, predicting which patients will benefit from neuromodulation remains one of the main challenges for this therapy. Therefore, this study aims to identify the variables that may correlate with nonresponders to high‐frequency (10 kHz) SCS to distinguish the subset of patients less likely to benefit from this intervention.Materials and MethodsThis was a retrospective single‐center observational study of patients who underwent 10 kHz SCS implant. Patients were divided into nonresponders and responders groups. Demographic data and clinical outcomes were collected at baseline and statistical analysis was performed for all continuous and categorical variables between the two groups to calculate statistically significant differences.ResultsThe study population comprised of 237 patients, of which 67.51% were responders and 32.49% were nonresponders. There was a statistically significant difference of high levels of kinesiophobia, high self‐perceived disability, greater pain intensity, and clinically relevant pain catastrophizing at baseline in the nonresponders compared to the responders. A few variables deemed potentially relevant, such as age, gender, history of spinal surgery, diabetes, alcohol use, tobacco use, psychiatric illness, and opioid utilization at baseline were not statistically significant.ConclusionOur study is the first in the neuromodulation literature to raise awareness to the association of high levels of kinesiophobia preoperatively in nonresponders to 10 kHz SCS therapy. We also found statistically significant differences with greater pain intensity, higher self‐perceived disability, and clinically relevant pain catastrophizing at baseline in the nonresponders relative to responders. It may be appropriate to screen for these factors preoperatively to identify patients who are less likely to respond to SCS. If these modifiable risk factors are present, it might be prudent to consider a pre‐rehabilitation program with pain neuroscience education to address these factors prior to SCS therapy, to enhance successful outcomes in neuromodulation.

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Non-Spinal Neuromodulation of the Lumbar Medial Branch Nerve for Chronic Axial Low Back Pain: A Narrative Review

Cited by 6 publications

References 45 publications

Basivertebral nerve ablation with concurrent lumbar laminotomy

Basivertebral nerve ablation with concurrent lumbar laminotomy

Best Practice Guidelines on the Diagnosis and Treatment of Vertebrogenic Pain with Basivertebral Nerve Ablation from the American Society of Pain and Neuroscience

Variables associated with nonresponders to high‐frequency (10 kHz) spinal cord stimulation

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