Patient selection, clinical outcomes, associated healthcare utilization, and cost-effectiveness of basivertebral nerve ablation for the treatment of vertebrogenic low back pain: A narrative review

TL;DR

This review examines how basivertebral nerve ablation helps treat chronic low back pain by focusing on patient selection, outcomes, healthcare use, and cost-effectiveness.

Contribution

The paper provides a comprehensive review of basivertebral nerve ablation's clinical effectiveness and cost-effectiveness for vertebrogenic low back pain.

Findings

BVNA provides sustained pain relief and functional improvements in vertebrogenic cLBP patients.

BVNA reduces healthcare utilization, opioid use, and surgical interventions.

BVNA is cost-effective compared to conventional management for this condition.

Abstract

Chronic low back pain (cLBP) represents a significant burden to global health, with a prevalence projected to reach 843 million individuals by 2050. Vertebrogenic cLBP, a distinct phenotype, is mediated by nociception transmitted through the basivertebral nerve. Advances in basic and translational science have established clinical imaging biomarkers of vertebrogenic cLBP, such Type 1 and 2 Modic changes, to more reliably identify this condition. Additionally, medical technology advances have provided the ability to selectively disrupt pain signaling from painful vertebral endplates by interosseous basivertebral nerve ablation (BVNA). The objective of this review is to highlight appropriate patient selection, clinical outcomes, associated healthcare utilization, and cost-effectiveness of BVNA in the treatment of vertebrogenic cLBP.

PubMed, EMBASE, and Google Scholar databases were queried for articles published before September 2024. Two authors reviewed references for eligibility, extracted data, and appraised the quality of evidence.

Patient selection criteria include the presence of Type 1 or Type 2 Modic changes on MRI in the context of clinical suspicion of anterior element spinal pain based on clinical evaluation. BVNA was found to result in clinically significant and sustained pain relief and functional improvements in individuals with vertebrogenic cLBP. Randomized controlled trials and systematic reviews demonstrate long-term efficacy, with clinically meaningful benefits sustained up to 5 years postprocedure. Healthcare utilization analyses indicate that BVNA significantly reduces low back pain-related healthcare utilization, opioid use, and surgical intervention rates. Economic analysis indicates that BVNA is cost-effective when compared to conventional management of vertebrogenic cLBP.

In appropriately selected patients, the overall body of evidence demonstrates that BVNA is an effective and durable treatment for vertebrogenic cLBP.

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