ISASS Policy Statement 2022: Literature Review of Intraosseous Basivertebral Nerve Ablation

Abstract

The index 2020 ISASS Guideline Statement "Intraosseous Ablation of the Basivertebral Nerve for the Relief of Chronic Low Back Pain" was generated in response to growing requests for background, supporting literature, evidence, as well as proper coding for intraosseous basivertebral nerve ablation. Since the guideline was published, the American Medical Association has added Current Procedural Terminology category I codes for basivertebral nerve ablation: 64628 and 64629. Additionally, the has recognized a need for greater specificity in differentiating various types of low back pain and has designatedthe International Classification of Diseases, 10th revision, Clinical Modification code M54.51, vertebrogenic low back pain, to ensure correct diagnosis. The timing of these additions provides an opportunity to refresh the ISASS Guideline to ensure proper diagnosis and procedural coding and to update the supporting literature and evidence.

Basivertebral Nerve Radiofrequency Ablation (Intracept)

“…6 This novel procedure has received published support from the International Society for the Advancement of Spine Surgery, American Society of Pain and Neuroscience, and North American Spine Society. 3,7,8 CONTRAINDICATIONS BVNA is contraindicated in patients with severe cardiac or pulmonary compromise, active implantable pulse generators (eg, pacemakers, defibrillators), targeted ablation zone(s) < 10 mm away from a sensitive structure not intended to be ablated such as the vertebral foramen, active systemic infection or local infection in treatment area, and those who are pregnant or skeletally immature. 9…”

“…Moreover, aggregate data from these studies further supports these positive clinical outcomes 6 . This novel procedure has received published support from the International Society for the Advancement of Spine Surgery, American Society of Pain and Neuroscience, and North American Spine Society 3,7,8 …”

Modic changes as seen on MRI are associated with nonspecific chronic lower back pain and disability

“…Until now, the field has been largely observational. With the observed clinical benefit in randomised controlled trials of basivertebral nerve ablation (BVNA) and its subsequent regulatory approval for the treatment of patients with MC1 and MC2 endplate oedema and vertebrogenic pain, the importance of identifying Modic changes has been recognised [5,[23][24][25][26]. BVNA treatment can provide clinically significant reductions in pain and disability [27].…”

“…BVNA treatment can provide clinically significant reductions in pain and disability [27]. The contribution of vertebral endplate and marrow damage, observed as MC1 or MC2 changes on MRI, to CLBP is becoming more widely appreciated and has led to the endorsement of the diagnostic selection of CLBP patients with MC1 or MC2 changes and the BVNA procedure by US learned societies [23,24]. The medical history and MRI-based diagnosis of vertebrogenic pain has been recognised with an International Classification of Diseases (10th Revision) diagnostic code M54-51 [28].…”