Synergistic Effects of Basivertebral Nerve Ablation Plus Schroth Therapy for Adult Scoliosis: A Multicenter...

Schroth therapy improves outcomes in mild degenerative scoliosis but may be insufficient for patients with vertebrogenic pain linked to vertebral endplate changes. Basivertebral nerve ablation (BVNA) is a novel intervention that may provide additional benefit in these cases.

This retrospective, propensity score-matched cohort study included adults aged ≥ 18 years with idiopathic or degenerative scoliosis (Cobb angle ≥ 20°) and vertebrogenic pain, treated between January 1, 2020 and January 31, 2024, across two major healthcare systems. A subset received BVNA between December 5, 2022 and December 5, 2024. Propensity score matching was performed 1:1 for age, sex, body mass index, baseline disability and pain scores, and prior therapy sessions, yielding 44 matched patients (22 per group). The primary outcome was ≥ 15-point improvement in Oswestry Disability Index (ODI) at 12 months. Secondary outcomes included ≥ 3-point pain reduction, opioid and health-resource utilization, and complications.

Among 76 patients (mean [standard deviation] age 68.8 [14.8] years; 82.9% female), 44 were included in the matched analysis. At 12 months, patients receiving Schroth therapy plus BVNA achieved greater ODI improvement (mean change - 22.3 vs - 15.1; P = 0.03) and were more likely to reach ≥ 15-point ODI improvement (81.8% vs 59.1%; OR 2.58 [95% CI 1.01-6.60]; P = 0.048). Opioid use declined more in the BVNA group (- 37% vs - 14%, P = 0.037), with progressive MEDD reduction (19 → 10 mg) compared with stable use in the Schroth-only group (17 → 17 mg; group × time P = 0.003). Rates of subsequent pain procedures (81.8% vs 13.6%, P < .001) and ER visits for chronic back pain (63.6% vs 9.1%, P = 0.0004) were higher for Schroth-only patients. No complications were reported.

In adults with scoliosis and vertebrogenic pain, combining BVNA with Schroth therapy was associated with superior outcomes at 12 months compared with Schroth therapy alone.