Basivertebral Nerve Ablation

Abstract This chapter focuses on chronic low back pain caused by degenerative endplate disease. Animal and cadaver studies have shown this pain is transmitted from the vertebral endplate through the basivertebral nerve (BVN). In the setting of vertebral endplate disruption, there is an upregulation in the nerve endings of the BVN, and thus an increase in pain at this location. MRI in patients with degenerative endplate disease shows edema, which is characterized as Modic type I and type II change. Patients with chronic low back pain who have failed 6 months of conservative care and who have active Modic changes on MRI can be treated with a BVN ablation. The BVN is accessed with a cannula via a transpedicular approach. The target for the ablation is near the center of the lumbar and sacral vertebral bodies before the BVN arborizes to each endplate. Once proper access is obtained, ablation is performed at a constant 85°C for 15 minutes. The procedure takes approximately 30 minutes per level treated, and the patient returns home the same day. The evidence for BVN ablation is supported by two Level l randomized clinical trials. At this time, BVN ablation is approved for vertebral levels L3 to S1. Given the robust evidence and its relatively low risk profile, BVN ablation should be considered in patients who present with chronic low back pain.