Basivertebral nerve ablation for vertebrogenic low back pain

Overview

Some long-lasting low back pain comes from the bones of the spine themselves. This is called vertebrogenic pain. Inside each bone (vertebra) is a small nerve called the basivertebral nerve. When the top and bottom surfaces of the bone, called the end plates, wear down or get damaged, this nerve can send pain signals. Basivertebral nerve ablation is an outpatient procedure that uses gentle heat to stop this nerve from sending those signals. It may help some people who have had low back pain for at least six months that has not improved with other care.

Watch: how basivertebral nerve ablation works

Video: “Intracept Procedure (Overview)” from Chronic Pain Relief by Boston Scientific on YouTube. It loads from youtube-nocookie.com only when you press play. Shown for general education; GSMC did not produce it. Watch on YouTube

What it is

Basivertebral nerve ablation is done using the Intracept® system. "Ablation" means using heat to turn off a nerve's ability to send pain signals. A thin probe is placed inside the vertebra, near the basivertebral nerve, and radiofrequency energy heats the nerve. No implant is left behind.

Intracept® is a trademark of Boston Scientific.

Who it's for

Basivertebral nerve ablation may help people who have:

• Chronic low back pain for at least six months
• At least six months of conservative care, such as therapy and medicines, without enough relief
• A deep, central low back ache that is often worse with sitting, bending or activity
• An MRI showing Modic type 1 or type 2 changes (signs of end plate damage) at the painful levels, from L3 to S1

Basivertebral nerve ablation is not designed to treat sciatica or leg pain from a pinched nerve.

What the procedure involves, step by step

1. Before: we review your MRI to look for Modic changes. If your MRI is older, a new one may be needed.
2. Anesthesia: the procedure is done as an outpatient, usually with sedation or anesthesia.
3. Access: using live X-ray guidance, your physician makes a small opening in the back and guides a thin tool into the vertebra.
4. Ablation: a radiofrequency probe is placed near the basivertebral nerve, and gentle heat is applied.
5. Repeat if needed: this may be done at more than one level.
6. Finish: the tools are removed and small bandages are placed. The procedure usually takes about an hour.
7. Going home: most people go home the same day.

Recovery and what to expect

• Soreness at the treatment site for several days is common.
• Most people return to light activity within a few days.
• Some people notice a change in their back pain within weeks. For others it takes longer, and some people do not improve.
• Your physician may suggest physical therapy to help you build strength and activity.

Candidacy: who may or may not be a good fit

May be a good fit: adults with long-lasting central low back pain whose MRI shows Modic type 1 or 2 changes at L3 to S1, and who have not improved enough with at least six months of conservative care.

May not be a good fit: people whose main pain is in the leg (such as sciatica), people with an active infection, a tumor or recent fracture in the spine, severe osteoporosis, pregnancy, or certain implanted devices. Pain from other sources, such as the facet joints or SI joint, may need a different treatment.

Risks in brief

Risks include soreness at the site, bleeding, infection and a short-term increase in pain. Nerve injury is rare. Pain may not improve. Sedation or anesthesia also carries risks. We will review your specific risks with you.

Alternatives

Other options may include physical therapy, medicines, activity changes, injections, radiofrequency ablation of the facet joint nerves (for facet pain), spinal cord stimulation or, for some people, spine surgery.

Frequently asked questions

Insurance and Coverage for basivertebral nerve ablation

Basivertebral nerve ablation is a minimally invasive treatment for certain types of chronic low back pain. Like many specialized procedures, coverage varies from one insurance plan to the next. Knowing your benefits ahead of time can make the process easier.

Many plans require prior authorization for basivertebral nerve ablation. They may also ask for records showing your diagnosis, imaging results and the treatments you've already tried. Whether Basivertebral nerve ablation is right for you depends on a careful evaluation, and our team will walk you through each step.

Garden State Medical Center participates with all Aetna plans, including Aetna HMO. Whatever your insurance, we encourage you to call so we can check your benefits before your visit. Aetna HMO plans may require a referral from your primary care physician.

If chronic low back pain is affecting your daily life, we'd be glad to talk with you. Call 732-202-3000 to verify your benefits or schedule a consultation with a GSMC provider.

Insurance

Garden State Medical Center participates with all Aetna plans, including Aetna HMO, and works with many other insurance carriers. Coverage for any procedure depends on your plan, and prior authorization may be required. Our staff is happy to help verify your benefits and explain what to expect before treatment. Please call 732-202-3000 with your insurance card handy, and we'll help you take the next step.

See accepted insurance

Related pages

Related conditions

• Vertebrogenic pain
• Low back pain
• Degenerative disc disease

Related treatments and resources

• Radiofrequency ablation
• ReActiv8 restorative neurostimulation