Basivertebral nerve ablation is a procedure used to treat chronic low back pain originating from damaged vertebral endplates.
Endplates are located between the vertebral bodies and intervertebral discs. They protect the vertebrae and discs from compressive loads on the spine and facilitate the transport of nutrients to the intervertebral discs.
The endplates contain a cluster of nerve fibers that branch out from the basivertebral nerve. When a vertebral endplate becomes damaged, the basivertebral nerve fibers transmit pain signals from the endplate to the brain.
The damaged endplate changes can be seen on an MRI scan as Modic changes type 1 and type 2. Many spinal conditions, including lumbar degenerative disc disease, are known to cause damage to the vertebral endplates.
Basivertebral nerve ablation begins with the patient lying face-down on a table. Relaxing medication is given to produce sedation. A local anesthetic is injected into the skin to numb the tissue in the targeted area.
Next, the physician creates a small incision and, using x-ray guidance, inserts a hollow tube, called a cannula, through the pedicle and into the vertebra.
A radiofrequency probe is then inserted through the cannula to the precise area in the vertebral body where the basivertebral nerve is located. The tip of the probe is heated and applied to the nerve for approximately 7-15 minutes to create a heat lesion.
The instruments are then removed, and the incision is closed using dissolvable stitches or surgical glue.
A small bandage is placed on the injection site. The patient is monitored for a short time before being discharged home.
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