Intraosseous basivertebral nerve (BVN) ablation is a minimally invasive procedure developed as a therapeutic option for treating chronic low back pain (LBP). The chronic LBP often associated with vertebral endplate changes and Modic changes can be particularly challenging to treat, leading to a search for innovative solutions like BVN ablation. This technique focuses on the basivertebral nerve, a sensory nerve within the vertebral body, believed to contribute to pain transmission in these conditions.
The procedure involves the use of a specialized device to deliver radiofrequency energy, ablating the basivertebral nerve and disrupting its ability to transmit pain signals. This is carried out under image guidance, which helps in accurate localization of the nerve to avoid unnecessary damage to surrounding tissues. The device is inserted percutaneously through a small incision, limiting the damage to soft tissues, reducing the risk of infection, and promoting quicker recovery times compared to traditional open surgical procedures.
Patients suitable for BVN ablation often suffer from chronic LBP that does not respond to conservative treatments, and have diagnostic imaging evidence of vertebral endplate changes, and Modic changes. The procedure is contraindicated in patients with a history of vertebral fractures, active infections, or tumors in the vertebral body, and in those with certain types of systemic diseases that may increase the risk of complications.
A number of studies have shown promising results with BVN ablation. Patients often report significant reductions in pain and improvements in function following the procedure, enabling them to return to their daily activities. Some studies have shown the effects of BVN ablation can last up to 2 years post-procedure, indicating its potential as a long-term solution for chronic LBP. Moreover, the procedure has been found to have a favorable safety profile, with a low incidence of complications.
Despite these promising results, it is important to note that BVN ablation is not a universal solution for all forms of LBP. It is specifically targeted towards pain stemming from vertebral endplate and Modic changes. Other forms of LBP, such as those due to disc herniation, facet joint arthritis, or spinal stenosis, may not respond to this treatment.
The procedure also does not replace the need for a comprehensive, multi-disciplinary approach to managing LBP. It is most effective when used as part of a wider treatment plan, including physical therapy, medication management, and lifestyle modifications. Additionally, more research is needed to further delineate the optimal candidates for this procedure, long-term efficacy, and potential risks.
Intraosseous basivertebral nerve ablation has emerged as a potential game-changer in the management of chronic low back pain associated with vertebral endplate and Modic changes. By disrupting pain transmission from the basivertebral nerve, this minimally invasive procedure can significantly reduce pain and improve function, providing much-needed relief for patients who have not responded to traditional treatments. As we continue to refine our understanding of the role of the basivertebral nerve in LBP, and further refine the techniques used in BVN ablation, this treatment modality is set to become an integral part of the toolkit for managing chronic LBP.