Vertebrogenic Back Pain

Overview

Vertebrogenic pain results from structural changes in the spine, especially in the vertebral endplates. The endplates are thin layers of cartilage that separate the vertebral bodies from the intervertebral discs, and they play a key role in shock absorption. When these endplates are damaged or degenerate, it can lead to inflammation and activation of the basivertebral nerve, which is responsible for transmitting pain signals.

Patients with vertebrogenic pain often report chronic, debilitating lower back pain that does not respond well to traditional therapies such as physical therapy, medications, or injections. Diagnosis typically involves imaging studies, such as MRI, to identify Modic changes—specific signs of inflammation or degeneration in the vertebral bodies.

Indications

Patients who may benefit from treatments like basivertebral nerve ablation generally meet the following criteria:

• Chronic Lower Back Pain: Persistent pain for six months or longer that is unresponsive to conservative treatments (physical therapy, pain medications, injections).
• Modic Changes: Evidence of vertebral endplate changes (Modic Type 1 or 2) on MRI, which are often indicative of vertebrogenic pain.
• Non-Surgical Candidates: Patients who are not ideal candidates for spinal fusion or other major surgeries due to health conditions, age, or personal preferences.

Pre-Procedure

• Imaging and Diagnosis: A thorough evaluation with imaging techniques, particularly MRI, is necessary to confirm the presence of vertebrogenic pain and Modic changes.
• Consultation: A detailed discussion with a spine specialist or interventional pain physician to evaluate whether basivertebral nerve ablation is suitable.
• Preparation: Prior to the procedure, patients are advised to refrain from taking certain medications (such as blood thinners), and fasting may be required.

During the Procedure

• Anesthesia: The procedure is typically performed under local anesthesia with sedation, though some cases may involve general anesthesia depending on patient preference and medical considerations.
• Procedure: A small incision is made in the back, through which a radiofrequency probe is inserted. This probe is guided to the vertebral body where it ablates (destroys) the basivertebral nerve, thereby interrupting pain transmission.
• Duration: The procedure generally takes about one hour, depending on the complexity of the case and the number of vertebrae being treated.

Post-Procedure

• Recovery: Patients can usually return home the same day, with instructions to avoid strenuous activity for a few days to weeks. Mild discomfort at the treatment site is expected but typically resolves quickly.
• Follow-Up: Patients are usually advised to follow up with their physician within a few weeks to assess progress and healing.
• Pain Relief Timeline: While some patients may experience immediate pain relief, it often takes a few weeks for the full effect to be noticeable as inflammation subsides and the nerve ablation takes effect.