What is vertebrogenic low back pain and how does ablation help?

The spine is a marvel of mechanical engineering: a column of bones strong enough to protect the spinal nerves and bear the weight of the upper body, yet flexible enough to move in many directions. One aspect of the spine’s ingenious design is that each of its 33 bones, or vertebrae, are separated by cushiony layers that provide support and shock absorption. When these interlocking spinal structures are healthy and injury-free, a person can move, bend and sit freely. Unfortunately, for some, these layers can degenerate with time and wear, resulting in pain.

One layer notorious for its role in low back pain is a rubbery padding between the vertebrae called discs. But there’s yet another layer that can trigger chronic pain. Sandwiching each vertebra are nerve-rich barriers of spongy bone called endplates. If the endplates become damaged, their nerves relay signals to the brain, resulting in a condition called vertebrogenic pain. Typical symptoms are an unrelenting pain in the center of the lower back that becomes worse when the person bends forward, lifts something, is active or sits down for long periods of time.

Of the approximately 30 million people in the U.S. with chronic back pain, one in six is likely to have vertebrogenic pain.[1] Yet while the condition is common, it is a relatively new diagnosis. As a result, vertebrogenic pain is often misdiagnosed, leading many patients to pursue therapies that don’t resolve the issue, including physical therapy, chiropractic care, injections, medications and even opioids.

Fortunately, vertebrogenic pain has telltale physical symptoms and a clear diagnostic test, as well as a proven solution: a minimally invasive treatment called basivertebral nerve ablation.

What is basivertebral nerve ablation?

The process begins with an examination of a patient’s physical symptoms. Also crucial to a diagnosis is a magnetic resonance imaging (MRI) scan of the patient’s vertebrae. A doctor inspects the scan for any telltale signs of endplate degeneration, including inflammation, edema and changes to bone marrow, any of which could indicate a diagnosis of vertebrogenic pain. For patients with these visible changes on their MRIs – and who have also had low back pain for at least six months that hasn’t responded to first-line care – an ablation treatment can stop the affected nerve from sending out pain signals.

The procedure is straightforward and usually takes about an hour. With a patient under anesthesia, the doctor makes two tiny incisions in the low back and inserts a small probe. The probe reaches inside the affected vertebra and finds the basivertebral nerve, which carries pain signals from an endplate to the brain. Finally, the probe emits radiofrequency energy that heats the base of the basivertebral nerve, interrupting its transmissions. Watch how it works:

The procedure leaves behind no implants or hardware. Importantly, it also preserves the overall structure of the spine, so that if the patient suffers from multiple types of spine conditions, they can still receive other treatment options in the future. Patients can go home the same day as their procedures and have a brief recovery. They often begin feeling relief from their low back pain within as little as two weeks.[2][3][4]

Proven, implant-free relief from vertebrogenic pain

Only one basivertebral nerve ablation system is cleared by the U.S. Food and Drug Administration (FDA) for treatment of vertebrogenic back pain: the Intracept™ Intraosseous Nerve Ablation System. Clinical studies have shown that after receiving the procedure:

• Patients experienced significant improvements in pain and function at five years after a single treatment.[5]
• At five years, more than one-third of patients reported feeling completely pain-free and about two-thirds say they have resumed the level of activity they enjoyed before their low back pain.⁵
• Some patients significantly lowered their use of opioids or injections in the long term.⁵
• Nearly 80% of patients in a long-term study said they would have the procedure again for the same condition.⁵

In addition to its durability, basivertebral nerve ablation with the Intracept system is also clinically proven to be safe.[6] In 2023, Boston Scientific acquired the technology, expanding access to patients on a larger scale.

“Raising awareness of this diagnosis and treatment is crucial to helping the millions of people living with vertebrogenic pain,” says Ray Baker, M.D., vice president and chief medical officer of Neuromodulation at Boston Scientific. “This revolutionary therapy is proven to not only relieve this specific type of chronic low back pain but to change patients’ lives.” Already, more than 30,000 patients have been treated with the procedure, and access to it only continues to expand due to increased insurance coverage – allowing even more people to enjoy life without chronic low back pain.

Learn more about vertebrogenic pain and its treatment with basivertebral nerve ablation.