Hello, my name is Dr. Jessica Beetham, and today I will be presenting basal vertebral nerve radiofrequency ablation, potential benefits at initial follow-up appointment. About 30 million people are affected by chronic low back pain each year in the U.S. alone. Chronic low back pain can be described as lasting greater than six months, and it has several causes, such as changes in facet joints, intervertebral discs, and vertebral end plates. To find the main etiology of the pain involves determining the exact location of the pain, which movements cause the pain, and the use of diagnostic imaging. Vertebrogenic low back pain occurs with specific movements, including extended periods of sitting and bending forward. On MRIs, the vertebral bodies have superior and inferior end plates, which have specific changes called modic changes when vertebrogenic low back pain is present. There are a total of three different types of modic changes. Modic type 1 changes are symbolic of inflammation. On T1-weighted MRIs, they appear as decreased signal intensity. On T2-weighted MRIs, they appear as increased signal intensity. Modic type 2 changes are symbolic of fatty infiltrate of bone marrow. On both T1-weighted and T2-weighted MRIs, these changes appear as increased signal intensity. Modic type 3 changes appear as decreased signal intensity on T1- and T2-weighted images. A newer treatment of vertebrogenic low back pain for patients who have failed conservative treatment for at least six months and have modic changes in the L3 to S1 region is radiofrequency ablation of the basal vertebral nerve using the FDA-approved device called Intracept. Contraindications for this procedure include the presence of spinal infections, pregnancy, or the presence of active implantable pulse generators like defibrillators and pacemakers. For this study, the objective was to determine if basal vertebral nerve radiofrequency ablation will decrease vertebrogenic low back pain using the visual analog scale at baseline and the initial follow-up appointment. A retrospective chart review was performed from January 2022 through April 2024 to find which patients received the radiofrequency ablation of the basal vertebral nerve and to analyze the benefit each patient received. Inclusion criteria was that each patient had tried six months of conservative care and had modic type 1 or type 2 changes present on MRI. Exclusion criteria for the chart review included patient having severe cardiac or pulmonary disease, having the presence of an active infection, failing to use the visual analog scale to grade the level of pain, or if the patient was at least 18 years of age or older. The visual analog scale score was used both before and approximately 10 days after the procedure to determine if a patient received benefit. All of the procedures were performed by Dr. Donald Erb. The bottom portion of this slide describes in detail the basal vertebral nerve radiofrequency ablation. For the results overall, a total of 52 patients had the basal vertebral nerve radiofrequency ablation and of those, 26 were male patients and 26 were female patients. After using the inclusion and exclusion criteria, two male patients were excluded and one female patient was excluded since all of them had not reported a visual analog scale score after the procedure. The chart shows the age of each patient, the sex, if spinal stenosis was present, if the patient had a therapeutic intervention approximately in the six months before or the six-month time period after the procedure, plus the visual analog scale score at the baseline and then at that initial follow-up appointment. There is a total of 15 patients, nine of which were male and six females, out of the total of 49 patients who received benefit. To determine if a patient had benefit, the American Society of Pain and Neuroscience guideline that a visual analog scale difference of two or more indicates improvement was utilized for this chart review. Limitations of this study include having a small sample size and there was not a control. Some patients actually had an increase in their subjective pain after the procedure, such as patients number four and seven. Even though these patients actually had a decrease in their visual analog scale score, both of them had a radicular-like pain, which was treated with the transforaminal epidural steroid injection based on the location of their pain. Overall, prior research has shown the baso-vertebral nerve radiofrequency ablation is a method to treat for tubergenic low back pain. This study demonstrates the need to expand how patient's pain is analyzed before and after the procedure. Therefore, further research over a longer time frame with the use of a more detailed scale like the Oswestry Disability Index are needed to fully see how patients are aided by this procedure. Below at the bottom of this slide are the references. Thank you for watching this presentation.

basal vertebral nerve

radiofrequency ablation

chronic low back pain

Intracept device

Modic changes