Assistant Professor University of Alabama at Birmingham
Diana Kokash: No financial relationships to disclose
Jesse Jones, MD: Cerenovus: Consultant (Ongoing), Research Grant Recipient (Ongoing), Speaking and Teaching (Ongoing); MIVI: Consultant (Ongoing); Protara: Advisory Committee or Review Panel Member (Ongoing), Consultant (Ongoing)
Learning Objectives: Basivertebral nerve ablation (BVNA) is procedure in which thermal ablation is used to destroy the basivertebral nerve to alleviate low back pain. Herein the authors will describe the process by which they perform BVNA starting with patient selection and ending with post operative management and followup.
Background: Low back pain (LBP) is the most ubiquitous cause for musculoskeletal ailment in the USA. Basivertebral nerve ablation is a recently approved procedure for patients suffering from LBP. The basivertebral nerve lays within the posterior-central region of the vertebral body and receives signals from the superior and inferior endplate prior to carrying these nociceptive signals to the spinal cord. Ablation of the BVNA stops this pathway and results in pain relief with recent studies demonstrating almost 90% of patients improving by >50%. The procedure itself can be performed under image guidance whether it be fluoroscopic or via CT. Targeted ablation of the BVN is relatively straightforward when using proper landmarks and technique.
Clinical Findings/Procedure Details:
Patient Selection: Evaluation in Clinic, Indications, Contraindications, Pre-operative Imaging
Procedural Considerations: Anticoagulation hold, Antibiotic choice, Anesthesia type (moderate sedation vs general), Patient positioning (prone), Image Guidance (CT vs Fluoro)
Anatomic Landmarks: Vertebral body anatomy, transpedicular access, location of BVN on AP/LAT fluoro and on CT
Post operative care and follow-up: Toradol 30mg IV, Ice packs, lidocaine patches. Clinic visits post op
Conclusion and/or Teaching Points: Basivertebral nerve ablation is a relatively new procedure that has been hugely impactful for helping patients who have low back pain. It is a safe and effective procedure when properly performed but there are key nuances such as the precise location of the BVN that one must know before performing this procedure.