Intra-osseous basivertebral nerve radiofrequency ablation (BVA) for the treatment of vertebrogenic chronic low back pain

Vivo, Aldo Eros De; D’Agostino, Giovanni; D’Anna, Gennaro; Qatami, Hosam Al; Gil, Inês; Ventura, Fausto; Manfrè, L.

doi:10.1007/s00234-020-02577-8

Cited by 23 publications

(37 citation statements)

References 30 publications

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“…The visual analog scale (VAS) was the outcome tool utilized to measure pain perception by all clinical studies that assessed changes in pain outcomes. 6–10 , 12–14 , 30 , 31 In the study by Becker et al (2017), although VAS was not the primary endpoint, the authors reported an improvement in VAS from 61±22 pre-operative (baseline) to 38±30 and 45±35 at 6-week and 3-month follow-ups, respectively, which were statistically significant findings (p<0.05). However, this study lacked a control group and, without a control arm, it is difficult to determine whether these improvements were the results of regression to the mean, natural disease progression, device placebo effect, or an alternative intervention not captured in the study.…”

Section: Discussionmentioning

confidence: 92%

“…At 12-months follow-up, VAS decreased significantly compared to baseline, and the mean decrease was 4.3 cm, with 54 out of 56 patients (96.4%) reporting a VAS decrease of at least 3.0 cm (greater than the MCID). 30 It is noteworthy that 5-year long-term follow-up data from Fischgrund et al (2020) reported that very few (4%) patients received spinal interventions (such as epidural steroid injections) in the preceding five-years, suggesting that pain was substantially controlled without the need of other spinal interventions at 5-year follow-up postoperatively from the BVN RFA. This is quite remarkable, considering that a great number of patients (up to 70%) had CLBP at baseline for more than five years and had received at least one injection within that timeframe and had failed conservative treatments for CLBP.…”

Section: Discussionmentioning

confidence: 99%

“…Clinical success, defined as ≥10 points reduction in ODI, was achieved in 96.5% of patients (54/56). 30 …”

Section: Discussionmentioning

confidence: 99%

“…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 .…”

Section: Discussionmentioning

confidence: 99%

“…Most studies reviewed reported ODI as the tool of choice to measure functional outcomes at multiple follow-up periods, which were variable per each individual study. [6][7][8][9][10][12][13][14]30,31 Becker et al (2017) concluded that BVN RFA significantly improved functional outcomes for up to 1-year during the study period, as measured by ODI. 13 The primary endpoint of ODI at 3-month follow-up demonstrated statistically significant therapeutic benefit, reducing the ODI from 52 preintervention to 23 post-intervention (p<0.001).…”

Section: Bvn Rfa Impacts On Functional Outcomesmentioning

confidence: 99%

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

Francio¹,

Sherwood²,

Twohey³

et al. 2021

JPR

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Historically, intervertebral disc degeneration has been the etiological target of chronic low back pain; however, disc degeneration is not necessarily directly associated with pain, and many other anatomical structures are potential etiologies. The vertebral endplates have been postulated to be a source of vertebral pain, where these endplates become particularly susceptible to increased expression of nociceptors and inflammatory proliferation carried by the basivertebral nerve (BVN), expressed on diagnostic imaging as Modic changes. This is useful diagnostic information that can help physicians to phenotype a subset of low back pain, which is known as vertebral pain, in order to directly target interventions, such as BVN ablation, to this significant pain generator. Therefore, this review describes the safety, efficacy, and the rationale behind the use of BVN ablation, a minimally invasive spinal intervention, for the treatment of vertebral pain. Our current literature review of available up-to-date publications utilizing BVN ablation in the treatment of vertebral pain suggests that there is limited, but moderate-quality evidence that this is an effective intervention for reduction of disability and improvement in function, at short- and long-term follow-up, in addition to limited moderate-quality evidence that BVN RFA is superior to conservative care for pain reduction, at least at 3-month follow-up. Our review concluded that there is a highly clinical and statistically significant treatment effect of BVN ablation for vertebral pain with clinically meaningful benefits in pain reduction, functional improvements, opioid dose reduction, and improved quality of life. There were no reported device-related patient deaths or serious AEs based on the available literature. BVN ablation is a safe, well-tolerated and clinically beneficial intervention for vertebral pain, when proper patient selection and surgical/procedural techniques are applied.

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