What is Basivertebral Nerve Ablation?
Basivertebral nerve ablation (BVNA) is a minimally invasive procedure designed to relieve chronic low back pain originating from the vertebral endplates, which are the top and bottom surfaces of the vertebrae. This type of pain is often referred to as vertebrogenic pain. The procedure involves the use of radiofrequency energy to ablate (or destroy) the basivertebral nerve (a nerve located within the vertebral body), which is thought to be a source of this pain.
Indications for Basivertebral Nerve Ablation
Basivertebral nerve ablation is typically indicated when conservative treatments such as physical therapy, medications, and epidural steroid injections have failed to provide adequate pain relief for patients with chronic low back pain that is thought to originate from the vertebral endplates (vertebrogenic pain).
However, you may not be a good candidate for BVNA if you have contraindications to the procedure, such as severe cardiopulmonary diseases, certain infections, bleeding disorders, osteoporosis, or other medical conditions that might increase the risk of complications.
Preparation for Basivertebral Nerve Ablation
In general, preparation for basivertebral nerve ablation may include the following:
- Comprehensive assessment to confirm that the patient is a suitable candidate for basivertebral nerve ablation.
- Diagnostic imaging, typically an MRI, to identify degenerative changes in the vertebral endplates, which are indicative of inflammation or degeneration linked to vertebrogenic pain.
- Review of patient’s medical history and current medications.
- Patients may be asked to fast for a certain period before the procedure.
- Medication adjustments may be recommended, particularly anticoagulants which may need to be temporarily discontinued.
- Obtain written informed consent from the patient after a detailed explanation of the procedure, including its purpose, benefits, risks, and potential complications.
Procedure for Basivertebral Nerve Ablation
Basivertebral nerve ablation is typically performed on an outpatient basis, allowing patients to return home the same day. In general, the procedure may involve the following steps:
- The patient is positioned prone (lying face down) on the procedure table.
- Local anesthesia and/or conscious sedation are administered to keep the patient comfortable.
- Fluoroscopy (real-time X-ray) or CT guidance is used to precisely locate the target vertebrae.
- A small incision is made in the skin over the target vertebra.
- A specialized needle or cannula is inserted through the incision and advanced into the vertebral body under imaging guidance.
- Through the cannula, an ablation probe is inserted and positioned at the center of the vertebral body, targeting the basivertebral nerve.
- Proper placement of the probe is confirmed using fluoroscopy or CT imaging.
- Radiofrequency energy is delivered through the probe to heat and ablate the basivertebral nerve.
- The duration and temperature of the ablation are controlled to ensure effective nerve destruction while minimizing damage to surrounding tissues.
- Once the ablation is complete, the probe and cannula are carefully removed.
- The small incision is closed with surgical glue or dissolvable stitches.
Post-Procedure Care and Recovery
In general, post-procedure care and recovery for basivertebral nerve ablation may include the following:
- The patient is monitored in a recovery area for a short period to ensure there are no immediate complications.
- Vital signs are checked, and the patient is observed for any adverse reactions to the anesthesia or procedure.
- Patients are usually discharged the same day with instructions on activity restrictions and pain management.
- Instructions on wound care and signs of infection to watch for at the incision site are provided.
- A follow-up appointment is scheduled to assess the patient's response to the procedure and monitor for any delayed complications.
- Physical therapy or other rehabilitative measures may be recommended to support recovery and improve outcomes.
Risks and Complications
Potential risks and complications of basivertebral nerve ablation may include:
- Infection
- Bleeding
- Nerve damage
- Pain at the treatment site
- Failure to relieve pain
Benefits
Basivertebral nerve ablation procedure offers several benefits, such as:
- Minimally invasive
- Targeted/effective pain relief
- Reduced need for pain medications
- Quick recovery time
- Long-lasting results
- Improved function and quality of life
- Alternative to more invasive surgeries
- Cost-effective
- High success rate and patient satisfaction