Chronic low back pain
Symptoms have persisted for at least six months and remain meaningful despite an appropriate course of conservative care.
BASIVERTEBRAL NERVE ABLATION
A targeted treatment for vertebrogenic low back pain.
Basivertebral nerve ablation (BVNA) is a minimally invasive radiofrequency procedure designed for carefully selected patients with chronic low back pain arising from damaged vertebral endplates.
VERTEBROGENIC PAIN
Not all low back pain comes from the same place.
In some patients, chronic low back pain is associated with changes at the vertebral endplates—the interfaces between the vertebral bodies and the discs. These endplates are supplied by the basivertebral nerve and can become a source of pain.
MRI findings known as Modic Type 1 or Type 2 changes can support a diagnosis of vertebrogenic pain when they fit the patient’s symptoms and clinical evaluation. Imaging alone does not determine whether BVNA is appropriate.
PATIENT SELECTION
Who may be a candidate?
BVNA is intended for a specific subset of patients with chronic low back pain. A careful evaluation is important because many other structures can also cause back pain.
Compatible MRI findings
MRI demonstrates Type 1 or Type 2 Modic changes at one or more vertebral endplates in the appropriate lumbar levels.
Clinical fit
The history, examination, imaging, and overall pain pattern support the vertebral endplates as a likely pain generator.
Other causes considered
The evaluation considers competing sources of pain and whether another diagnosis better explains the patient’s symptoms.
THE PROCEDURE
How basivertebral nerve ablation works.
Using image guidance, a specialized probe is advanced through the pedicle into the vertebral body and positioned near the basivertebral nerve. Controlled radiofrequency energy is then used to ablate the nerve, reducing its ability to transmit pain signals from the vertebral endplates.
The procedure treats the nerve inside the vertebral body. It is different from medial branch radiofrequency ablation, which targets nerves associated with the facet joints.
EVIDENCE & EXPECTATIONS
Clinical evidence in appropriately selected patients.
Randomized clinical trials and long-term follow-up studies have demonstrated improvements in pain and function after BVNA in appropriately selected patients with vertebrogenic chronic low back pain. Individual outcomes vary, and the procedure is considered only when the clinical evaluation and imaging support vertebrogenic pain as the likely pain generator.
Diagnosis firstBVNA is not a general treatment for every type of low back pain.
Selection mattersSymptoms, examination, MRI findings, and prior treatment are considered together.
Function mattersThe goal is meaningful improvement in pain, function, and quality of life.
WHAT TO EXPECT
A plan built around the diagnosis.
Before treatment
Your evaluation includes a review of symptoms, prior treatment, examination findings, and lumbar imaging to determine whether vertebrogenic pain is a reasonable diagnosis.
Procedure day
BVNA is performed using image guidance. Procedure-specific instructions regarding medications, eating or drinking, transportation, and arrival time are provided in advance.
After treatment
Recovery and activity guidance are individualized. Improvement may evolve over time rather than occurring immediately, and follow-up is used to assess pain, function, and progress.
FREQUENTLY ASKED QUESTIONS
Common questions about BVNA.
Is BVNA the same as a facet radiofrequency ablation?
No. BVNA targets the basivertebral nerve within the vertebral body. Facet radiofrequency ablation targets the medial branch nerves associated with the facet joints. The procedures are intended to address different pain generators.
What are Modic changes?
Modic changes are MRI findings involving the vertebral endplates and adjacent bone marrow. Type 1 and Type 2 changes may support a diagnosis of vertebrogenic pain when they are consistent with the patient’s symptoms and overall clinical picture.
Does having Modic changes mean I need BVNA?
No. MRI findings are only one part of the evaluation. Symptoms, examination findings, prior treatment, and other potential sources of pain must also be considered.
How quickly will I know whether it worked?
Response varies from patient to patient, and improvement may develop over time rather than immediately after the procedure. Follow-up is used to assess changes in pain, function, and overall progress.
Is BVNA appropriate for every patient with chronic low back pain?
No. BVNA is intended for appropriately selected patients whose clinical picture is consistent with vertebrogenic pain. A focused evaluation is needed to determine whether the procedure is an appropriate treatment option.
NEXT STEP
Could your low back pain be vertebrogenic?
A focused evaluation can help determine the likely pain generator and whether basivertebral nerve ablation may be an appropriate part of your treatment plan.
Request an AppointmentThis page provides general educational information and does not replace an individualized medical evaluation. Treatment recommendations, risks, benefits, alternatives, and expected recovery vary by patient and should be discussed with a qualified healthcare professional.