Percutaneous Image-Guided Basivertebral Nerve Radiofrequency Ablation for Chronic Low Back Pain

1. 
   

   To review etiology, clinical presentation, diagnostic imaging, and treatment options for chronic low back pain. 
   



2. 
   

   To describe indications, procedural techniques, outcomes, adverse effects, and clinical efficacy for percutaneous radiofrequency ablation of basivertebral nerves.
   

Low back pain is a ubiquitous concern in healthcare, posing many challenges due to its variation in etiology and presentation. Vertebral body degenerative changes can be visualized on MRI and classified as Modic type changes of the endplate marrow, with a high specificity for correlating with chronic vertebrogenic axial low back pain. Basivertebral nerve (BVN) ablation is an emerging procedure that provides relief to patients with chronic low back pain that is unresponsive to treatment.

Clinical Findings/Procedure Details:

Patient selection for radiofrequency ablation (RFA) for chronic vertebrogenic low back pain involves physical exam, documentation of impaired function, and evaluation of imaging to identify Modic type changes of the lumbar vertebral bodies. The BVN, which is the main nociceptive carrier from damaged vertebral endplates, is targeted.

Radiofrequency ablation of the BVN is performed with the patient in the prone position. Local anesthesia with 1% lidocaine is administered and a small dermatotomy is made with a scalpel. Under fluoroscopic guidance, a cannula assembly is advanced through the target vertebral pedicle starting with a superolateral access point. The introducer needle is removed and a curved cannula assembly is advanced to create a channel to the trunk of the BVN in the posterior 1/3 of the vertebral body at the midline of the bone. A radiofrequency probe is inserted into the curved path and placed at the trunk of the BVN. The nerve is then ablated for 15 minutes at 85 degrees Celsius. This procedure can be repeated in a single session if there are multiple vertebral targets. The trocars are then withdrawn and hemostasis is achieved with manual compression or pressure dressings. Patients should be monitored for vital signs and neurological function after the procedure.

Available studies demonstrate no reports of spinal cord injury, avascular necrosis, or post-procedure infection. BVN RFA has become increasingly recommended in patients with pain greater than five years in duration that is unresponsive to prior treatment.

Conclusion and/or Teaching Points: Basivertebral nerve ablation is a novel, minimally invasive treatment option that has been shown to provide relief to patients whose chronic vertebrogenic low back pain has not improved with alternative treatment.