Vertebrogenic Pain And Basivertebral Nerve Ablation (Intercept Procedure)

Low back pain is the most common cause of activity limitation in adults. While multiple treatments may be used to treat chronic low back pain, they may prove to be only moderately effective and/or of temporary duration. Chronic low back pain has been associated with different causes such as disc degeneration and discogenic pain, attributed to pain signals arising from nerves in the disk as well as arthritic changes affecting the nerves in the spinal joints.

The existence and role of nerves in the different spinal structures is well documented. It turns out that the actual bone, i.e. the intervertebral bodies composing the spine are heavily innervated and have specific nerve structures capable of contributing heavily to the low back pain experience. These nerve structures are typically implicated in the pain syndrome in patients with degeneration of the vertebral bone, particularly those adjacent to the intervertebral disks. Increased density of neural pain receptors in the parts of the vertebral bodies adjacent to the disks and called the endplates strongly suggests that these endplates and vertebral bodies could be the sources of pain in patients with degenerative disease of the spine.

Specific mapping of human vertebral body nerves called basivertebral nerves (BVN) has also been done and it has been confirmed that these nerves carry pain signals. Thus, it has been demonstrated that in some patients the origin of low back pain is the vertebral endplates, and that pain is transmitted through signals emanating in the BVN complex.

Patients who feel pain with bending, sitting, standing and lifting and who have specific findings on lumbar MRI (magnetic resonance imaging study) could be good candidates for this treatment.

Radiofrequency ablation of the BVN for the relief of chronic low back pain (Intracept Procedure) represents a treatment modality which uses direct approach into the vertebral body to access the BVN complex and alleviate the vertebrogenic pain. The treatment uses radiofrequency energy to heat the portion of the basivertebral nerve and disrupt the pain signal traveling from the inflamed degenerative endplates to the brain. As a result, this procedure tends to offer patients with degenerative disease of the vertebral bones a lasting pain relief.

Intracept Procedure Q&A

What is the success rate of the intracept procedure?

Clinical trials report that the success rate of the Intracept procedure is 69%, with 64% of patients experiencing a greater than 50% reduction in pain after 12 months. In the multicenter randomized trial involving 147 actively treated patients compared to placebo 75.6% reported meaningful improvement 3 months after the treatment.

How long does it take to recover from basivertebral nerve ablation?

This is an outpatient procedure where most patients experience a full recovery within one to two weeks post-procedure. However, there is no need for bed rest after the procedure is performed and patients are typically advised to modify their activity according to how they feel.

What is the downside of basivertebral nerve ablation?

On occasion, permanent nerve damage or pain can occur. In some people, their original pain may get worse. However, this is a rare occurrence. Other complications, including infection and bleeding at the needle insertion site, are also uncommon.

Is Intracept covered by insurance?

Although Intracept is a fairly new procedure, Medicare and many insurance plans will cover it so long as the following criteria are met: You've had chronic low-back pain for at least six months. Physical therapy, injections, medications, and other conservative treatments have not significantly reduced your pain. You have clinical findings of vertebrogenic low back pain and MRI shows appropriate vertebral endplate changes.

Is Intracept done under sedation?

We perform the Intracept Procedure in our outpatient surgery center with intravenous sedation. The procedure typically takes 40 to 80 minutes, depending on how many vertebral bodies are being treated. With sedation employed patients tend to be comfortable during and after the procedure in the recovery room.

Are the results of Intracept procedure permanent?

Yes, the ablation of the basivertebral nerve is permanent, meaning the targeted nerve will no longer transmit pain signals. At this point repeating the ablation of basivertebral nerve is not recommended although theoretically it can be done as it is a minimally invasive intervention.

How long has the Intracept procedure been around?

Relievant Medical Systems began developing this treatment in 2006 and eventually introduced Intracept Procedure. It has been rigorously studied in at least 4 clinical studies including 2 randomized controlled trials which published long term follow up data ( 5+ years) showing strong safety profile, meaningful clinical improvements, durable  and consistent results.