90 - Multifidus Atrophy and Basivertebral Nerve Ablation Treatment Failure

Monday, March 31, 2025

12:10 PM – 1:10 PM CT

Location: Music City Center, Expo Poster Area

Author/Co-author(s)

AS

Allie Stamper, BS

MS2
University of Alabama at Birmingham, United States
DM

Desmin Miner, MD

Assistant Professor, Division of Neuroradiology
University of Alabama at Birmingham, United States
Junaid Raja, MD

Assistant Professor
University of Alabama Birmingham, United States
VK

Venkatesh P. Krishnasamy, MD (he/him/his)

Associate Professor
University of Alabama at Birmingham, United States
JJ

Jesse Jones, MD

Assistant Professor
University of Alabama at Birmingham, United States
TS

Thomas Staner, MD

Clinical Professor of Neurosurgery
University of Alabama at Birmingham, United States

Poster Presenter(s)

Junjian Huang, MD

Assistant Professor
Emory University School of Medicine, United States

Purpose: Basivertebral nerve ablation (BVNA) is a minimally invasive procedure used to provide relief to patients experiencing vertebrogenic low back pain. Multiple studies have shown that BVNA is highly efficacious and durable however there are a subset of patients who do not get relief with this procedure. Back pain is often multifactorial and is influenced by muscular, osseous, and ligamentous factors. Preoperative MRI usually excludes ligamentous injury and the osseous component is the target for treatment. Therefore it is possible that fatty infiltrate (FI) in the multifidus muscle may correlate with clinical treatment failure of BVNA.

Materials and Methods: A retrospective chart review was conducted on BVNA patients using data from May 2022 to March 2024. Patients without sufficient follow-up data were excluded from the study, and those with adequate follow-up were scored by degree of FI in the multifidus muscle by a board-certified neuroradiologist. Patient charts were evaluated to determine pain outcomes following BVNA. Fisher Exact test was used in R.

Results:

A total of 38 patients were included in the study, 6 received a Grade 0 (G0, < 10% FI), 23 received a Grade 1 (G1, 10-50% FI), and 9 received a Grade 2 (G2, >50% FI). Approximately 82% of patients (n=31) got relief following BVNA: 6/6 (100%) G0 patients, 19/23 (82%) G1 patients, and 6/9 (67%) G2 patients. While there appeared to be a correlation between multifidus atrophy and clinical failure, this did not reach statistical significance.

Conclusion: Multifidus atrophy is strongly correlated with low back pain, radiculopathy, and is a marker for surgical frailty. This study, while underpowered, has scratched the surface of a potential imaging biomarker for BVNA treatment failure.