Assessing Clinical Predictors of 12-Month Outcomes for Basivertebral Nerve Ablation in Vertebrogenic Low Back Pain

To evaluate 12-month outcomes of basivertebral nerve ablation (BVNA) for the treatment of vertebrogenic low back pain (LBP) and identify clinical predictors of changes in pain and functional status.

Materials and Methods:

An IRB-approved retrospective study was performed to evaluate 28 patients who underwent BVNA between May 2022 and September 2023 for vertebrogenic (LBP) at a single academic center. Baseline pain and level of function using the visual analog scale (VAS) and Oswestry Disability Index (ODI), respectively, were assessed and re-evaluated at follow-up. A student’s t-test was used to compare pre and post procedure VAS and ODI. Demographic (age, gender, BMI) and baseline clinical characteristics including duration of LBP, history of back surgery and prior pain interventions were assessed. Previous pain interventions included sacroiliac joint (SIJ) interventions, posterior column (PC) interventions including medial branch nerve block/ablation, and epidural steroid injections (ESI). Univariate regression was used to evaluate demographic and clinical variables as predictors of improvement in VAS and ODI. Patients were excluded if VAS or ODI data were unavailable.

Results:

Thirteen out of 28 patients (58 ± 15.6 years, 7/13 male) completed 12-month follow-up after BVNA. Patients had an average BMI of 28.3 ± 7.4 and duration of LBP of 12 ± 9.8 years. Prior to BVNA, 11/13 (85%) patients required one or more pain interventions, 10/13 (77%) required ESI, 4/13 (31%) required SIJ interventions, and 8/13 (61%) required PC interventions. 9/13 (69%) patients required 2 or more types of pain intervention. At 1-year post-BVNA, ODI was significantly reduced compared to pre-procedure (pre 25.2 ± 6.5 vs post 11.3 ± 8.5, p=0.00009) while VAS showed a trend towards improvement in pain (pre 7.6 ± 1.6 vs post 6 ± 3.4, p=0.07).

Patients who had a higher number of pain interventions prior to BVNA (p=0.028) and prior PC interventions (p=0.036) correlated with a decrease in VAS, while patients with a longer duration of LBP trended towards less improvement after BVNA (0.071). Lower patient age (p=0.005) correlated with improvement in ODI. In the 12-month follow up period, 6/13 (46%) patients required repeat pain intervention, however only 1/6 of those patients required more than one type of pain intervention.

Conclusion:

Twelve months after BVNA, patients showed significant improvement in functional status, as measured by ODI, and a trend toward improvement in VAS pain score. History of prior PC interventions correlated with improvement in VAS, while lower patient age correlated with improvement in ODI.