Three-Level Basivertebral Nerve Ablation for Chronic Vertebrogenic Low Back Pain
Clinical Question
Can patients with chronic vertebrogenic low back pain who have not achieved meaningful long-term improvement despite appropriate conservative treatment experience substantial functional improvement following Basivertebral Nerve Ablation?
Show labels EnlargeSagittal lumbar MRI. Multilevel degenerative disc disease with Modic endplate changes most pronounced at L5–S1 and additional changes at L4–L5. De-identified · no PHI.
- Treated vertebral levels
- L4 · L5 · S1
- #Imaging findings
- 1Modic endplate changeL4–L5 · associated with mild degenerative spondylolisthesis
- 2Modic endplate changeL5–S1 · most pronounced
Reading the Imaging
The MRI is interpreted together with the patient's history, examination, and treatment response.
- Patient Overview
A 59-year-old woman presented with chronic axial low back pain that had progressively limited her daily activities despite prolonged conservative treatment, including physical therapy, medication management, and spinal injections.
Her pain was localized primarily to the lower lumbar spine and was aggravated by prolonged sitting, walking, bending, twisting, and routine daily activities, resulting in a significant reduction in quality of life.
- Clinical Evaluation
Following review of the patient's history, physical examination, prior treatment response, and lumbar MRI, vertebrogenic pain was considered a significant contributor to her chronic symptoms.
MRI demonstrated multilevel degenerative disc disease with Modic endplate changes most pronounced at L5–S1, with additional Modic endplate changes at L4–L5 associated with mild degenerative spondylolisthesis. Correlation of the imaging findings with the patient's history, physical examination, pain pattern, and unsuccessful response to conservative treatment supported treatment of the L4, L5, and S1 vertebral levels.
A three-level Basivertebral Nerve Ablation was subsequently performed.
Fluoroscopic Images of Radiofrequency Ablation Probe Placement
Under fluoroscopic guidance, paired anteroposterior (AP) and lateral images were obtained to confirm radiofrequency ablation (heater) probe position within the vertebral body at each treated level — S1, L5, and L4 — using the Stryker OptaBlate BVN System.
Anteroposterior (AP) view
S1 and L5 vertebral bodies
Anteroposterior (AP) image demonstrating the Stryker OptaBlate heater probes positioned within the S1 and L5 vertebral bodies.
Lateral view
S1 and L5 vertebral bodies
Lateral image of the same S1 and L5 levels, confirming the depth of the Stryker OptaBlate heater probes within the vertebral bodies.
Anteroposterior (AP) view
L5 and L4 vertebral bodies
Anteroposterior (AP) image demonstrating the Stryker OptaBlate heater probes positioned within the L5 and L4 vertebral bodies.
Lateral view
L5 and L4 vertebral bodies
Lateral image confirming placement of the Stryker OptaBlate heater probes within the L5 and L4 vertebral bodies.
The Clinical Course
Improvement following BVNA is frequently progressive; early symptoms are not the final outcome.
- Early Recovery
At the initial postoperative follow-up, the patient reported only modest improvement while continuing to recover from the procedure. Surgical healing was appropriate, and no procedure-related complications were identified.
She was counseled that improvement following BVNA is frequently progressive and that early postoperative symptoms should not be considered the final clinical outcome.
- Long-Term Outcome
By approximately 12 weeks following the procedure, the patient reported an estimated 85% reduction in the chronic axial low back pain that had previously limited her quality of life.
She described substantially improved activity tolerance, increased daily function, and meaningful improvement in everyday activities compared with her pre-procedure baseline.
At a Glance
≈85%
reduction in chronic axial low back pain by ~12 weeks
Patient
59-year-old female
Diagnosis
Chronic vertebrogenic low back pain
Prior treatment
More than six months of unsuccessful conservative care
Procedure
Three-level BVNA (L4, L5, S1)
Recovery
Progressive over the first several months
Outcome
≈85% improvement by 12 weeks
Clinical Pearl
Successful Basivertebral Nerve Ablation begins with careful patient selection. MRI findings should always be interpreted together with the patient's history, physical examination, and response to previous conservative treatment. Although some patients improve rapidly, others continue to experience meaningful improvement during the first several months following treatment.
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