Skip to main content

Advertisement

SpringerLink
Log in

Intra-osseous basivertebral nerve radiofrequency ablation (BVA) for the treatment of vertebrogenic chronic low back pain

  • Interventional Neuroradiology
  • Published:
Neuroradiology Aims and scope Submit manuscript

Abstract

Study design

Prospective experimental uncontrolled trial.

Background

Vertebrogenic pain is a frequently underestimated cause of chronic low back pain (LBP). Vertebral endplate degeneration, characterized by cortical bone damage and subchondral bone inflammatory reaction, is a significant source of LBP, the responsible of the pain transmission being the Basivertebral Nerve (BVN). Radiofrequency ablation of the BVN (BVA) leads to thermal injury of nerve tissue and interruption of the of chronic vertebrogenic pain transmission.

Purpose

The aim of this study is to evaluate the effectiveness, in terms of pain and disability reduction, of percutaneous (BVA) in treating patients affected by vertebrogenic chronic LBP. Moreover, as a secondary endpoint, the purpose is to assess the feasibility and safety of a percutaneous CT-guided technique.

Methods

We performed percutaneous CT-guided BVN ablation in 56 consecutive patients presenting with vertebrogenic chronic LBP in local anesthesia using an articulating bipolar radiofrequency electrode (STAR™ Tumor Ablation System Merit). A 1-month follow-up MRI was performed to evaluate the ablation area in order to assess the target success of the procedure. A 3-month follow-up CT study was performed to evaluate bone mineral density in order to exclude structural bone abnormalities that might have been induced by the treatment. Pre- and post-procedure pain and disability levels were measured using the visual analogue scale (VAS) and Oswestry Disability Index (ODI). A 2-cm improvement threshold was set as clinical success for the VAS score and a 10-point improvement threshold was set as clinical success for the ODI score.

Results

At 3- and 12-month follow-up, VAS and ODI scores decreased significantly compared to baseline. Clinical success was reached in 54/56 patients (96.5%) for pain and 54/56 patients (96.5%) for disability, exceeding significantly the MCID. CT-assisted targeting of the ablation zone was determined successful in 100% of patients. Mean operative time was 32 min. No immediate or delayed complications were detected.

Conclusions

Percutaneous CT-guided intra-osseous BVA seems to be a safe, fast, and powerful technique for pain relief in patients with vertebrogenic chronic LBP, when the selection of patients is based on a multidisciplinary approach including both conventional Diagnostic Radiology and Nuclear Medicine imaging.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Määttä JH, Wadge S, MacGregor A, Karppinen J, Williams FMK (2015) ISSLS prize winner: vertebral endplate (modic) change is an independent risk factor for episodes of severe and disabling low back pain. Spine (Phila Pa 1976) 40(15):1187–1193

    Article  Google Scholar 

  2. Luoma K, Vehmas T, Kerttula L, Grönblad M, Rinne E (2016) Chronic low back pain in relation to Modic changes, bony endplate lesions, and disc degeneration in a prospective MRI study. Eur Spine J 25(9):2873–2881

    Article  Google Scholar 

  3. Chung CB, Vande Berg BC, Tavernier T, Cotten A, Laredo JD, Vallee C, Malghem J (2004) End plate marrow changes in the asymptomatic lumbosacral spine: frequency, distribution and correlation with age and degenerative changes. Skelet Radiol 33(7):399–404

    Article  Google Scholar 

  4. Kääpä E, Luoma K, Pitkäniemi J, Kerttula L, Grönblad M (2012) Correlation of size and type of modic types 1 and 2 lesions with clinical symptoms: a descriptive study in a subgroup of patients with chronic low back pain on the basis of a university hospital patient sample. Spine (Phila Pa 1976) 37(2):134–139

    Article  Google Scholar 

  5. Albert HB, Manniche C (2007) Modic changes following lumbar disc herniation. Eur Spine J 16(7):977–982

    Article  Google Scholar 

  6. Kjaer P, Korsholm L, Bendix T, Sorensen JS, Leboeuf-Yde C (2006) Modic changes and their associations with clinical findings. Eur Spine J 15(9):1312–1319

    Article  Google Scholar 

  7. Fras C, Kravetz P, Mody DR, Heggeness MH (2003) Substance P–containing nerves within the human vertebral body: an immunohistochemical study of the basivertebral nerve. Spine J 3(1):63–67

    Article  Google Scholar 

  8. Bailey JF, Liebenberg E, Degmetich S, Lotz JC (2011) Innervation patterns of PGP 9.5-positive nerve fibers within the human lumbar vertebra. J Anat 218(3):263–270

    Article  Google Scholar 

  9. Antonacci MD, Mody DR, Heggeness MH (1998) Innervation of the human vertebral body: a histologic study. J Spinal Disord 11(6):526–531

    Article  CAS  Google Scholar 

  10. Lorio M, Clerk-Lamalice O, Beall DP, Julien T (2020) International Society for the Advancement of Spine Surgery guideline-Intraosseous ablation of the basivertebral nerve for the relief of chronic low back pain. Int J Spine Surg 14(1):18–25

    Article  Google Scholar 

  11. Fan KW, Zhu ZX, Den ZY (2005) An experimental model of an electrical injury to the peripheral nerve. Burns 31(6):731–736

    Article  Google Scholar 

  12. Coert JH (2010) Pathophysiology of nerve regeneration and nerve reconstruction in burned patients. Burns 36(5):593–598

    Article  Google Scholar 

  13. Lotz JC Basivertebral nerve ablation chronic results pre-clinical study for University of California San Francisco. Glob Spine J 03(EFirst):153–164

  14. Sherman MS (1963) The nerves of bone. JBJS 45(3)

  15. Liuzzi FJ, Tedeschi B (1991) Peripheral nerve regeneration. Neurosurg Clin N Am 2(1):31–42 http://www.ncbi.nlm.nih.gov/pubmed/1821734. Accessed January 9, 2020

    Article  CAS  Google Scholar 

  16. Pfirrmann CWA, Metzdorf A, Zanetti M, Hodler J, Boos N (2001) Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976) 26(17):1873–1878

    Article  CAS  Google Scholar 

  17. Ostelo RWJG, de Vet HCW (2005) Clinically important outcomes in low back pain. Best Pract Res Clin Rheumatol 19(4):593–607

    Article  Google Scholar 

  18. Hägg O, Fritzell P, Nordwall A (2003) The clinical importance of changes in outcome scores after treatment for chronic low back pain. Eur Spine J 12(1):12–20

    Article  Google Scholar 

  19. Carragee EJ, Don AS, Hurwitz EL, Cuellar JM, Carrino J, Herzog R (2009) 2009 ISSLS prize winner: does discography cause accelerated progression of degeneration changes in the lumbar disc: a ten-year matched cohort study. Spine (Phila Pa 1976) 34(21):2338–2345

    Article  Google Scholar 

  20. Rahme R, Moussa R (2008) The modic vertebral endplate and marrow changes: pathologic significance and relation to low back pain and segmental instability of the lumbar spine. Am J Neuroradiol 29(5):838–842

    Article  CAS  Google Scholar 

  21. Kuisma M, Karppinen J, Niinimäki J, Kurunlahti M, Haapea M, Vanharanta H, Tervonen O (2006) A three-year follow-up of lumbar spine endplate (Modic) changes. Spine (Phila Pa 1976) 31(15):1714–1718

    Article  Google Scholar 

  22. Mitra D, Cassar-Pullicino VN, Mccall IW (2004) Longitudinal study of vertebral type-1 end-plate changes on MR of the lumbar spine. Eur Radiol 14(9):1574–1581

    Article  CAS  Google Scholar 

  23. Luoma K, Vehmas T, Grönblad M, Kerttula L, Kääpä E (2009) Relationship of Modic type 1 change with disc degeneration: a prospective MRI study. Skelet Radiol 38(3):237–244

    Article  Google Scholar 

  24. Luoma K, Vehmas T, Grönblad M, Kerttula L, Kääpä E (2008) MRI follow-up of subchondral signal abnormalities in a selected group of chronic low back pain patients. Eur Spine J 17(10):1300–1308

    Article  Google Scholar 

  25. Ohtori S, Koshi T, Yamashita M, Yamauchi K, Inoue G, Suzuki M, Takaso M, Orita S, Eguchi Y, Ochiai N, Kishida S, Kuniyoshi K, Nakamura J, Aoki Y, Ishikawa T, Arai G, Miyagi M, Kamoda H, Takahashi K (2010) Existence of pyogenic spondylitis in Modic type 1 change without other signs of infection: 2-year follow-up. Eur Spine J 19(7):1200–1205

    Article  Google Scholar 

  26. Urquhart DM, Zheng Y, Cheng AC et al (2015) Could low grade bacterial infection contribute to low back pain? A systematic review. BMC Med 13(1)

  27. Albert HB, Sorensen JS, Christensen BS, Manniche C (2013) Antibiotic treatment in patients with chronic low back pain and vertebral bone edema (Modic type 1 changes): a double-blind randomized clinical controlled trial of efficacy. Eur Spine J 22(4):697–707

    Article  Google Scholar 

  28. McCartney M (2013) Antibiotics for back pain: hope or hype. BMJ 346(may14 2):f3122

    Article  Google Scholar 

  29. Russo VM, Dhawan RT, Dharmarajah N, Baudracco I, Lazzarino AI, Casey AT (2017) Hybrid bone single photon emission computed tomography imaging in evaluation of chronic low back pain: correlation with Modic changes and degenerative disc disease. World Neurosurg 104:816–823

    Article  Google Scholar 

  30. Harisankar CNB, Mittal BR, Bhattacharya A, Singh P, Sen R (2012) Utility of single photon emission computed tomography/computed tomography imaging in evaluation of chronic low back pain. Indian J Nucl Med 27(3):156–163

    PubMed  PubMed Central  Google Scholar 

  31. Khalil JG, Smuck M, Koreckij T, Keel J, Beall D, Goodman B, Kalapos P, Nguyen D, Garfin S, INTRACEPT Trial Investigators (2019) A prospective, randomized, multicenter study of intraosseous basivertebral nerve ablation for the treatment of chronic low back pain. Spine J 19(10):1620–1632

    Article  Google Scholar 

Download references

Funding

No funding was received for this study.

Author information

Authors and Affiliations

  1. Minimally Invasive Spine Therapy Department, I.O.M., Viagrande, Catania, Italy

    Aldo Eros De Vivo, Fausto Ventura & Luigi Manfrè

  2. Nuclear Medicine Dept. “Gravina”Hospital, Caltagirone, Catania, Italy

    Giovanni D’Agostino

  3. Radiology Unit, Humanitas Mater Domini, Castellanza, Varese, Italy

    Gennaro D’Anna

  4. Neuroscience Institution, Hamad General Hospital, Doha, Qatar

    Hosam Al Qatami

  5. Dept of Neuroradiology, Centro Hospitalar Lisboa Ocidental, Carnaxide, Portugal

    Ines Gil

Authors
  1. Aldo Eros De Vivo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Giovanni D’Agostino
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gennaro D’Anna
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hosam Al Qatami
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ines Gil
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Fausto Ventura
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Luigi Manfrè
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Aldo Eros De Vivo.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the studies involving human participants were in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

De Vivo, A.E., D’Agostino, G., D’Anna, G. et al. Intra-osseous basivertebral nerve radiofrequency ablation (BVA) for the treatment of vertebrogenic chronic low back pain. Neuroradiology 63, 809–815 (2021). https://doi.org/10.1007/s00234-020-02577-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00234-020-02577-8

Keywords

Search

Navigation