Intraosseous Basivertebral Nerve Radiofrequency Ablation for the Treatment of Vertebral Body Endplate Low Back Pain: Current Evidence and Future Directions

Adam Michalik, Aaron Conger, Matthew Smuck, Timothy P. Maus, Zachary L. McCormick

Research output: Contribution to journalReview articlepeer-review

Abstract

Recently, basivertebral nerve (BVN) radiofrequency ablation has been developed for the treatment of chronic low back pain (CLBP) thought to arise from the vertebral body endplates (VEPs). This review describes the relevant neuroanatomy and pathobiology of VEP degeneration and injury, imaging correlates of presumed VEP pain, randomized controlled trials performed, appropriate patient selection, and safety. Anatomic, histological, and clinical evidence supports the concept of the VEP as a source of CLBP and the nociceptive role of the BVN. BVN radiofrequency ablation appears to be an effective treatment for a subset of patients with CLBP and evidence of Modic change types 1 and 2 in the L3 to S1 VEPs who have failed to respond to conservative treatment. However, all studies performed to date have been industry sponsored, and future non-industry-funded trials will be needed to confirm these results.

Original languageEnglish (US)
Pages (from-to)S24-S30
JournalPain medicine (Malden, Mass.)
Volume22
DOIs
StatePublished - Jul 25 2021

Keywords

  • Basivertebral
  • Endplate
  • Interventional
  • Modic
  • Neurotomy
  • Spine

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine

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