Basivertebral nerve ablation is a completely percutaneous procedure performed under local anesthesia with the help of a bipolar articulating electrode that has two thermal sensors for reading the ablation zone.
The proximal sensor shows the temperature in the outer ablation zone, and the distal temperature in the center of the ablation zone. With fluoroscopic guidance, the articulating electrode enables navigation to the desired ablation site within the vertebral body.
Anesthesia and procedure
After anesthesia of the periarticular region and deep muscles, a 10 G coaxial introducer is introduced through a unilateral transpedicular approach.
The distal tip of the introducer is introduced 1 cm anterior to the posterior wall of the vertebral body with the aim of preventing thermal injury to the spinal cord and nerve branches. This area also represents the outer ablation zone. An articulating osteotome is then inserted through the introducer to make a preferential path for optimal positioning of the articulating electrode. The radiolucent part of the electrode, which represents the center of the ablation zone, is positioned in the center of the vertebral body, where there is a cluster of nerve branches of the basivertebral nerve.
Thermal ablation is performed using an RF generator until the distal temperature sensor reaches a temperature of 55 to 70 °C, creating a 15 x 20 cm ablation zone. When the proximal sensor reaches a temperature of 50 °C, the supply of RF energy is automatically interrupted.
The average operating time of the procedure is 30 minutes, and the active ablation time is up to 5 minutes.
Once destroyed, nerve branches do not regenerate. The procedure ends with the removal of the articulating electrode and the coaxial introducer.
Advantages
Data from studies indicate that in 80% of patients it is necessary to treat two vertebrae, which refers to one movable segment, and in other patients it is necessary to additionally treat one or two vertebrae, for a total treatment of two to three movable segments. Intraosseous ablation of the basivertebral nerve is supported by basic and fundamental clinical evidence, including a placebo-controlled randomized clinical trial level I and a randomized clinical trial level I versus standard, conservative treatment. Data collected over 24 months (2 years) suggest a sustained treatment effect.
All studies conducted confirm that basivertebral nerve ablation provides significant clinical improvements in pain and normal function within two years and is an excellent and extremely safe method of treatment.
This evidence supports ablation as a treatment option in a well-defined subset of patients with chronic low back pain.
According to the guidelines ISASS (International Association for the Advancement of Spinal Surgery) intraosseous ablation of the basivertebral nerve in the L3-S1 spinal segment is medically indicated in patients who meet the following criteria:
- chronic axial lower back pain lasting at least 6 months
- failure to treat pain with non-surgical methods for at least 6 months
- MR imaging indicating Modic Type 1 or 2 changes in at least one vertebral plate, in one or more segments from L3 – S1.