The Effectiveness of Intraosseous Basivertebral Nerve Radiofrequency Ablation for the Treatment of Vertebrogenic Low Back Pain: An Updated Systematic Review with Single-Arm Meta-analysis

Abstract

Objective To provide an estimate of the effectiveness of basivertebral nerve (BVN) radiofrequency ablation (RFA) to treat vertebrogenic low back pain (LBP). Design Systematic review with single-arm meta-analysis. Population Persons ≥18 years of age with chronic LBP associated with type 1 or 2 Modic changes. Intervention Intraosseous BVN RFA. Comparison Sham, placebo procedure, active standard care treatment, or none. Outcomes The proportion of patients treated with BVN RFA who reported ≥50% pain score improvement on a visual analog scale or numeric rating scale. The main secondary outcome was ≥15-point improvement in Oswestry Disability Index score. Methods Three reviewers independently assessed articles published before December 6, 2021, in MEDLINE and Embase. The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) framework was used to evaluate the overall quality of evidence. Results Of the 856 unique records screened, 12 publications met the inclusion criteria, representing six unique study populations, with 414 participants allocated to receive BVN RFA. Single-arm meta-analysis showed a success rate of 65% (95% confidence interval [CI] 51–78%) and 64% (95% CI 43–82%) for ≥50% pain relief at 6 and 12 months, respectively. Rates of ≥15-point Oswestry Disability Index score improvement were 75% (95% CI 63–86%) and 75% (95% CI 63–85%) at 6 and 12 months, respectively. Conclusion According to GRADE, there is moderate-quality evidence that BVN RFA effectively reduces pain and disability in most patients with vertebrogenic LBP. Further high-quality studies will likely improve our understanding of the effectiveness of this procedure.

The Effectiveness of Intraosseous Basivertebral Nerve Ablation in the Treatment of Nonradiating Vertebrogenic Pain: A Systematic Review

“…BVN bundle is a branch of the sinuvertebral nerves that enters the vertebral body through the central vascular foramen and innervates the vertebral endplates [ 7 ]. According to the immunohistochemical analysis, BVN contains a high density of nerve fibers that are rich in nociceptors and inflammatory mediators such as substance P, calcitonin gene-related peptide, and protein gene product 9.5, corroborating the nociceptive role of BVN in the conveyance of vertebrogenic pain signals in CLBP [ 1 - 5 , 7 , 12 , 20 ]. The endplates are vulnerable to calcification and damage due to excessive load from activities of daily living, physiological aging, and strains from disc degeneration [ 16 , 17 ].…”

“…Since 1990, the rate of LBP has been spiraling due to the increasing number of the aging population [ 13 ]. According to statistics, 577.0 million people were living with CLBP in the world in 2017 compared to 377.5 million in 1990, with a lifetime prevalence of 60% to 80% [ 1 , 2 , 12 , 14 ]. While some people will recover from LBP, a minority of this population will proceed to debilitating CLBP resulting in a high socioeconomic burden.…”

“…The hypersensitive nociceptors of the degenerating intervertebral disc, which originate from the annulus fibrosis, were once thought to be responsible for transmitting pain (annulogenic pain). Despite this, current research has demonstrated that the vertebral body endplate contributes significantly to the pathologic innervation linked to disc degeneration and transmits pain signals via the basivertebral nerve (BVN) (vertebrogenic pain) [ 1 , 2 , 4 , 17 , 18 ].…”

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

“…Conger et al have recently had an updated systematic review of the literature with a single-arm meta-analysis accepted for publication. 42 Of the 856 unique records screened, 12 publications met inclusion criteria, representing 6 unique study populations, with 414 participants allocated to receive BVNA. Single-arm meta-analysis showed a success rate of 65% (95% CI 51%-78%) and 64% (95% CI 43%-82%), for ≥50% pain relief at 6 and 12 months, respectively.…”

“…All nonserious events were transient in nature with a median time to resolution of 66.5 days and were typically treated with oral medication (written communication, Relievant Medsystems, Inc, March 2022). 41,42 In the review of serious adverse events in the MAUDE database, 1 incidence of procedure-related retroperitoneal hematoma and 1 incidence of postprocedure endplate fracture were reported since commercialization of the device in 2018. 43…”