A staged approach to treating chronic low back and radicular pain: Basivertebral nerve ablation in conjunction with...

Low back pain is the leading cause of disability worldwide and the course of treatment patients and clinicians pursue to help alleviate it can be difficult at times. When conservative approaches fail, patients may ultimately require surgical intervention. In the presence of predominant axial back pain of discogenic and/or vertebrogenic origin without deformity or spinal instability, fusion surgery is less likely to reliably result in an optimal outcome for the patient. Literature is growing in support of vertebrogenic pain as a primary etiology of axial low back pain, with the degenerated vertebral endplates and their associated basivertebral nerve as a therapeutic target. Intraosseous basivertebral nerve ablation is a minimally invasive treatment for treating chronic, axial low back pain that is attributed to pathologically degenerated vertebral endplates that has been shown to significantly improve pain and overall function in patients. Furthermore, patients with predominantly axial low back pain with associated neuropathic lower extremity pain can benefit from a staged approach utilizing intraosseous basivertebral nerve ablation in conjunction with traditional decompressive surgery.