Abstract
BackgroundDamaged or degenerated vertebral endplates are a significant cause of vertebrogenic chronic low back pain (CLBP). Modic changes are one objective MRI biomarker for these patients. Prior data from the treatment arm of a sham-controlled, RCT showed maintenance of clinical improvements at 2 years following ablation of the basivertebral nerve (BVN). This study reports 5-year clinical outcomes.MethodsIn total, 117 US patients were treated successfully with BVN ablation. Patient-reported outcomes of ODI, VAS, postablation treatments, and patient satisfaction were collected at a minimum of 5-years following BVN ablation. Primary outcome was mean change in ODI. Comparisons between the postablation and baseline values were made using an analysis of covariance with alpha 0.05.ResultsOf the 117 US treated patients 100 (85%) were available for review with a mean follow-up of 6.4 years (5.4–7.8 years). Mean ODI score improved from 42.81 to 16.86 at 5-year follow-up, a reduction of 25.95 points (p < 0.001). Mean reduction in VAS pain score was 4.38 points (baseline of 6.74, p < 0.001). In total, 66% of patients reported a > 50% reduction in pain, 47% reported a > 75% reduction in pain, and 34% of patients reported complete pain resolution. Composite responder rate using thresholds of ≥ 15-point ODI and ≥ 2-point VAS for function and pain at 5 years was 75%.ConclusionCLBP patients treated with BVN ablation exhibit sustained clinical improvements in function and pain with high responder rates at a mean of 6.4 years following treatment. BVN ablation is a durable, minimally invasive treatment for vertebrogenic CLBP.
Highlights
Vertebrogenic pain from degenerated or damaged vertebral endplates is an important source of chronic low back pain (CLBP) [1,2,3,4,5,6]
Studies have shown that damaged endplates allow for proinflammatory material from the nucleus pulposus to diffuse into the adjacent marrow, inciting an inflammatory cascade that results in bone marrow changes (Modic changes) and neovascularization [2, 4, 7
Immunohistochemical and anatomical studies have demonstrated endplate nociceptors with afferents to the basivertebral nerve (BVN), a branch of the sinuvertebral nerve located within the posterior vertebral body (VB) [6, 9]
Summary
Vertebrogenic pain from degenerated or damaged vertebral endplates is an important source of chronic low back pain (CLBP) [1,2,3,4,5,6]. In the presence of chemical or mechanical sensitization, pain signals from damaged endplates are transmitted to the central nervous system via the BVN and perceived as CLBP [1]. These findings led to the development of intraosseous ablation of the BVN using RF energy for the treatment of vertebrogenic CLBP. Patient-reported outcomes of ODI, VAS, postablation treatments, and patient satisfaction were collected at a minimum of 5-years following BVN ablation. Conclusion CLBP patients treated with BVN ablation exhibit sustained clinical improvements in function and pain with high responder rates at a mean of 6.4 years following treatment. BVN ablation is a durable, minimally invasive treatment for vertebrogenic CLBP
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