Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Dec;16(6):1084-1094.
doi: 10.14444/8362. Epub 2022 Oct 20.

ISASS Policy Statement 2022: Literature Review of Intraosseous Basivertebral Nerve Ablation

Morgan Lorio  1 , Olivier Clerk-Lamalice  2 , Milaris Rivera  3 , Kai-Uwe Lewandrowski  4
Affiliations

ISASS Policy Statement 2022: Literature Review of Intraosseous Basivertebral Nerve Ablation

Morgan Lorio et al. Int J Spine Surg. 2022 Dec.

Abstract

The index 2020 ISASS Guideline Statement "Intraosseous Ablation of the Basivertebral Nerve for the Relief of Chronic Low Back Pain" was generated in response to growing requests for background, supporting literature, evidence, as well as proper coding for intraosseous basivertebral nerve ablation. Since the guideline was published, the American Medical Association has added Current Procedural Terminology category I codes for basivertebral nerve ablation: 64628 and 64629. Additionally, the has recognized a need for greater specificity in differentiating various types of low back pain and has designatedthe International Classification of Diseases, 10th revision, Clinical Modification code M54.51, vertebrogenic low back pain, to ensure correct diagnosis. The timing of these additions provides an opportunity to refresh the ISASS Guideline to ensure proper diagnosis and procedural coding and to update the supporting literature and evidence.

Keywords: basivertebral nerve; chronic low back pain; intraosseous ablation; vertebrogenic pain.

PubMed Disclaimer

Conflict of interest statement

Declaration of Conflicting Interests: The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Modic change 1 (MC1) and Modic change 2 (MC2). Images A and B demonstrate decreased signal intensity of T1-weighted images and increased signal intensity on T2-weighted images, respectively (white arrows), corresponding to MC1 at the L5-S1 disc space. Images C and D correspond to L3-L4 MC2 characterized by increased endplate signal intensity on T1-weighted images and on T2-weighted images, respectively (white arrows). There are similar changes at the L4-L5 disc space (no arrows).
Figure 2
Figure 2
Mean ODI and mean VAS over time. These graphs depict the mean ODI and mean VAS at each study follow-up for each arm. A statistically significant and clinically meaningful difference between arms in mean ODI and VAS improvement was demonstrated at 6 months as well as from baseline/re-baseline for each timepoint in patients treated with BVNA, including in control patients that crossed to active treatment. BVNA, basivertebral nerve ablation; ODI, Oswestry Disability Index; SC, standard care; VAS, visual analog scale.
Figure 3
Figure 3
Multistudy comparison of functional improvement. Comparison of mean ODI over time for the 2 level I RCTs and the chronic low back pain single-arm study. *SMART RCT US per protocol treatment arm at mean of 6.4 years. **Standard arm re-baselined and offered active treatment at a median of 5.8 months. BVN, basivertebral nerve; ODI, Oswestry Disability Index; RCT, randomized clincial trial; SC, standard care.
Figure 4
Figure 4
Comparison of proportion of patients by percent reduction in VAS for the 2 level I RCTs and the chronic low back pain single arm study. BVN, basivertebral nerve; VAS, visual analog scale.
See this image and copyright information in PMC

References

    1. Institute for Health Metrics and Evaluation (IHME) . United States Profile. IHME, University of Washington; 2018. http://www.healthdata.org/node/5300. August 2021.
    1. Wu A, March L, Zheng X, et al. . Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the global burden of disease study 2017. Ann Transl Med. 2020;8(6):299. 10.21037/atm.2020.02.175 - DOI - PMC - PubMed
    1. Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S. Lancet low back pain series working group. What low back pain is and why we need to pay attention. Lancet. 2018;391(10137):2356–2367. 10.1016/S0140-6736(18)30480-X - DOI - PubMed
    1. Deyo RA, Dworkin SF, Amtmann D, et al. . Report of the NIH task force on research standards for chronic low back pain. J Pain. 2014;15(6):569–585. 10.1016/j.jpain.2014.03.005 - DOI - PMC - PubMed
    1. Mutubuki EN, Beljon Y, Maas ET, et al. . The longitudinal relationships between pain severity and disability versus health-related quality of life and costs among chronic low back pain patients. Qual Life Res. 2020;29(1):275–287. 10.1007/s11136-019-02302-w - DOI - PMC - PubMed

LinkOut - more resources