A prospective, randomized, multicenter study of intraosseous basivertebral nerve ablation for the treatment of chronic low back pain

Khalil, Jad G.; Smuck, Matthew; Koreckij, Theodore D.; Keel, John; Beall, Douglas P.; Goodman, Bradly S.; Kalapos, Paul; Nguyen, Dan; Garfin, Steven R.; Investigators, Intracept Trial

doi:10.1016/j.spinee.2019.05.598

Cited by 68 publications

(97 citation statements)

References 39 publications

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“…provocative discogram (Figure 4) can be done to confirm the diagnosis. Treatment options can be conservative treatment with physiotherapy [6,117], injection,fluoroscopic guided radiofrequency ablation [12,118] and recently to improve accuracy of radiofrequency ablation and ensure safety, we do radiofrequency ablation through endoscopic visualization with transforaminal endoscopic approach [10]. Interlaminar approach can be performed to do radiofrequency ablation of sinuverterbral nerve and basiverterbral nerve as well as shown in this study.…”

Section: Radiofrequency Ablationmentioning

confidence: 76%

Lumbar Degenerative Disease Part 1: Anatomy and Pathophysiology of Intervertebral Discogenic Pain and Radiofrequency Ablation of Basivertebral and Sinuvertebral Nerve Treatment for Chronic Discogenic Back Pain: A Prospective Case Series and Review of Literature

Kim

Jang

2020

IJMS

101

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Degenerative disc disease is a leading cause of chronic back pain in the aging population in the world. Sinuvertebral nerve and basivertebral nerve are postulated to be associated with the pain pathway as a result of neurotization. Our goal is to perform a prospective study using radiofrequency ablation on sinuvertebral nerve and basivertebral nerve; evaluating its short and long term effect on pain score, disability score and patients’ outcome. A review in literature is done on the pathoanatomy, pathophysiology and pain generation pathway in degenerative disc disease and chronic back pain. 30 patients with 38 levels of intervertebral disc presented with discogenic back pain with bulging degenerative intervertebral disc or spinal stenosis underwent Uniportal Full Endoscopic Radiofrequency Ablation application through either Transforaminal or Interlaminar Endoscopic Approaches. Their preoperative characteristics are recorded and prospective data was collected for Visualized Analogue Scale, Oswestry Disability Index and MacNab Criteria for pain were evaluated. There was statistically significant Visual Analogue Scale improvement from preoperative state at post-operative 1wk, 6 months and final follow up were 4.4 ± 1.0, 5.5 ± 1.2 and 5.7 ± 1.3, respectively, p < 0.0001. Oswestery Disability Index improvement from preoperative state at 1week, 6 months and final follow up were 45.8 ± 8.7, 50.4 ± 8.2 and 52.7 ± 10.3, p < 0.0001. MacNab criteria showed excellent outcomes in 17 cases, good outcomes in 11 cases and fair outcomes in 2 cases Sinuvertebral Nerve and Basivertebral Nerve Radiofrequency Ablation is effective in improving the patients’ pain, disability status and patient outcome in our study.

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Section: Radiofrequency Ablationmentioning

confidence: 76%

Lumbar Degenerative Disease Part 1: Anatomy and Pathophysiology of Intervertebral Discogenic Pain and Radiofrequency Ablation of Basivertebral and Sinuvertebral Nerve Treatment for Chronic Discogenic Back Pain: A Prospective Case Series and Review of Literature

Kim

Jang

2020

IJMS

101

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“…The mean change in ODI score in the RF and control groups at 3 months was -25.3 and -4.4 points, respectively. Following that analysis, the study halted enrollment of new participants and offered patients in the standard-of-care arm early crossover into the RF ablation arm [22]. Khalil et al expressed optimism that the benefits of RF ablation would be sustained beyond 3 months as they were through 24 months in the sham trial by Fischgrund et al [20].…”

Section: Basivertebral Nerve Ablation For the Treatment Of Vertebrogementioning

confidence: 99%

“…CLBP patients with MCs have been shown to be clinically different from those without, as patients with MCs report a greater frequency and duration of LBP episodes and have worse outcomes with conservative treatment and after discectomy [15][16][17][18][19]. To treat patients with CLBP associated with type 1 or 2 MCs, a minimally invasive procedure to ablate the BVN using radiofrequency energy was developed and shown to be safe and effective in initial pilot studies and randomized controlled trials (RCTs) [20][21][22][23]. The aim of this review is to summarize current literature on the epidemiology and risk factors, clinical presentation and diagnosis, pathophysiology, and anatomy of VBP and the use of BVN ablation in its treatment.…”

Section: Introductionmentioning

confidence: 99%

Basivertebral Nerve Ablation for the Treatment of Vertebrogenic Pain

et al. 2020

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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.

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“…For example, BML characteristics such as size, location, and type, i.e. fibrovascular versus fatty, may provide information for diagnosis, prognosis, and treatment planning [3][4][5]. The most widely used methodology for assessing endplate BML is based on the presence of signal intensity changes adjacent to the endplates on T 1 -and T 2 -weighted MRI, often called "Modic changes" (MC) [6].…”

Section: Introductionmentioning

confidence: 99%

Measurement of vertebral endplate bone marrow lesion (Modic change) composition with water–fat MRI and relationship to patient-reported outcome measures

et al. 2021

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Purpose Vertebral endplate bone marrow lesions (“Modic changes”, MC) are associated with chronic low back pain (CLBP). Bone marrow composition in MC is poorly understood. The goals of this study were to: (1) measure bone marrow fat fraction (BMF) in CLBP patients with MC using water–fat MRI and (2) assess the relationship between BMF measurements and patient-reported clinical characteristics. Methods In this cross-sectional study, 42 CLBP patients (men, n = 21; age, 48 ± 12.4 years) and 18 asymptomatic controls (men, n = 10; 42.7 ± 12.8 years) underwent 3 T MRI between January 2016 and July 2018. Imaging consisted of T1- and T2-weighted sequences to evaluate MC and spoiled gradient-recalled echo sequence with asymmetric echoes and least-squares fitting to measure BMF. BMF was compared between vertebrae with and without MC using mixed effects models. The relationship between the BMF measurements and patient-reported disability scores was examined using regression. Results Twenty-seven subjects (26 CLBP, 1 control) had MC, and MC presence coincided with significantly altered BMF. In MC 1, BMF was lower than endplates without MC (absolute difference −22.3%; p < 0.001); in MC 2, BMF was higher (absolute difference 21.0%; p < 0.001). Absolute BMF differences between affected and unaffected marrow were larger in patients with greater disability (p = 0.029–0.032) and were not associated with pain (p = 0.49–0.83). Conclusion BMF is significantly altered in MC. Water–fat MRI enables BMF measurements that may eventually form the basis for quantitative assessments of MC severity and progression.

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A prospective, randomized, multicenter study of intraosseous basivertebral nerve ablation for the treatment of chronic low back pain

Cited by 68 publications

References 39 publications

Lumbar Degenerative Disease Part 1: Anatomy and Pathophysiology of Intervertebral Discogenic Pain and Radiofrequency Ablation of Basivertebral and Sinuvertebral Nerve Treatment for Chronic Discogenic Back Pain: A Prospective Case Series and Review of Literature

Lumbar Degenerative Disease Part 1: Anatomy and Pathophysiology of Intervertebral Discogenic Pain and Radiofrequency Ablation of Basivertebral and Sinuvertebral Nerve Treatment for Chronic Discogenic Back Pain: A Prospective Case Series and Review of Literature

Basivertebral Nerve Ablation for the Treatment of Vertebrogenic Pain

Measurement of vertebral endplate bone marrow lesion (Modic change) composition with water–fat MRI and relationship to patient-reported outcome measures

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