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

Abstract

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.

Comparison of conventional fenestration discectomy with Transforaminal endoscopic lumbar discectomy for treating lumbar disc herniation:minimum 2-year long-term follow-up in 1100 patients

“…Patients were asked to use the Visual Analogue Scale (VAS) [ 13 ] to rate the severity of the pain in their lower back and legs before surgery, 1 month after and at the final follow-up appointment. A score of 0 points corresponded to no pain; 1 to 3 points, to slight pain; 4 to 6 points, to obvious pain that affected sleep but was still tolerable and 7 to 10 points, to intense, unbearable pain.…”

Basivertebral Nerve Ablation for the Treatment of Vertebrogenic Pain

“…According to the Macnab criteria, 17 had excellent outcomes, 11 had good outcomes, and 2 had fair outcomes. The authors subsequently concluded that ablation of both the sinuvertebral and BVN through RF is effective in improving pain and disability status [66].…”

“…They initially summarized the role of increased proinflammatory and cytokine activity in degenerative disc disease. They noted that BVN and sinuvertebral nerves are infiltrated with granulation tissue in response to these cytokines, leading to the production of pain in response to degenerative disc disease [65][66][67][68]. The authors subsequently suggested RF ablation of the sinuvertebral or BVN as a reliable, definitive, and minimally invasive palliative strategy to manage axial back pain.…”

Advanced Strategies for the Regeneration of Lumbar Disc Annulus Fibrosus

“…These techniques provided thermal energy to the AF layers in order to denature collagen fibrils locally and seal the rupture site. Severe AF defects are unlikely to be treated by these methods and their contribution to IVD degeneration in the long term is not known [ 46 , 47 , 48 , 49 , 50 ].…”