Timing and trajectory of pain and functional outcomes after basivertebral nerve ablation: a prospective cohort study

Basivertebral nerve ablation (BVNA) is an FDA-cleared treatment for vertebrogenic low back pain. However, limited data exist detailing the specific timing and durability of patient-reported relief.

To characterize the weekly temporal trajectory of patient-reported ≥50 % pain relief and evaluate the predictive value for short-term and sustained response.

This prospective observational cohort study included 86 consecutive patients with MRI-confirmed Modic Type 1 or 2 changes treated with intraosseous BVNA between April 2024 and April 2025 at an academic center. Patients reported weekly pain relief for 8 weeks, then again at 12 and 24 weeks. Primary outcomes were time to first ≥50 % relief and the positive and negative likelihood ratios (LR⁺, LR^-) of early improvement for predicting response. Secondary outcomes included changes in Oswestry Disability Index (ODI), Numeric Rating Scale (NRS), and adjunctive spine interventions.

Pain reduction was rapid and durable: By Week 1, 34 % of patients achieved ≥50 % relief, increasing to 76 % by Week 3 and 91 % by Week 6. These improvements plateaued through Week 12 and persisted at 24 weeks. Median time to first ≥50 % relief was 3 weeks. Early responders (Week 3) were 6.6 times more likely to maintain relief at Week 12 (LR⁺ = 6.56, 95 % CI 2.50-17.0); predictive utility peaked at Weeks 4-6 (LR⁺ 7.1-9.0; LR^- ≤ 0.13). Mean ODI improved from 66.5 ± 13.5 to 32.3 ± 15.8 and NRS from 8.3 ± 1.5 to 3.0 ± 2.6 (p < 0.0001 for both). Nearly 90 % achieved ≥15-point ODI and ≥2-point NRS improvement; 21 % were pain-free by Week 12. Use of adjunctive spine injections declined from 86 % pre-procedure to 22 % post-procedure (p < 0.0001).

This is the first study to prospectively characterize the weekly time course of response following BVNA and demonstrates early, substantial, and durable improvements in pain and function. Most patients experienced meaningful relief within 3-6 weeks, and early response was sustained through 24 weeks. These findings support BVNA as a robust real-world intervention for vertebrogenic pain and highlight the prognostic value of early pain trajectory monitoring in predicting sustained outcomes.