Eur J Musculoskel Dis 2021 Gen-Apr;10(1):25-32
EVALUATION STUDY
NEW TREATMENT OF CHRONIC VERTEBROGENIC LOW BACK PAIN: THE BASIVERTEBRAL NERVE CT-GUIDED RADIOABLATION
A.E. De Vivo1, G. D’Agostino2, G. D’Anna3, H. Al Qatami4, I. Gil5, F. Ventura1, M. Bonetti6 and L. Manfrè1
1Minimal Invasive Spine Department, Mediterranean Institute for Oncology, Viagrande, Catania, Italy;
2Nuclear Medicine Department, “Gravina” Hospital, Caltagirone, Catania, Italy;
3Radiology Unit, Humanitas Mater Domini, Castellanza, Varese, Italy;
4Neuroscience Institution, Hamad General Hospital, Doha, Qatar;
5Department of Neuroradiology, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal;
6Department of Neuroradiology, Istituto Clinico Città di Brescia, Brescia, Italy
Correspondence to:
Luigi Manfrè, MD
Corso Italia 10, 95129 Catania, Italy
e-mail: lmanfre@me.com
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Received:23 January 2021 Copyright: |
ISSN: 2038-4106 This publication and/or article is for individual use only and may not be further reproduced without written permission from the copyright holder. Unauthorized reproduction may result in financial and other penalties. Disclosure: All authors report no conflicts of interest relevant to this article. |
ABSTRACT
Among the causes of chronic low back pain (LBP), vertebrogenic pain is frequently underestimated. A significant source of LBP is vertebral endplate degeneration, characterized by cortical bone damage and subchondral bone inflammatory reaction. The nerve responsible for pain transmission is the basi-vertebral nerve (BVN). Radiofrequency ablation of the BVN (BVA) leads to thermal injury of nerve tissue and interruption of chronic vertebrogenic pain transmission. The aim of this study is to evaluate the effectiveness, in terms of pain and disability reduction, of percutaneous BVA in the treatment of patients affected by vertebrogenic chronic LBP. A second aim is to assess the feasibility and safety of a percutaneous CT- guided technique. We performed percutaneous CT-guided BVN ablation in 56 consecutive patients presenting with vertebrogenic chronic LBP in local anaesthesia using an articulating bipolar radiofrequency electrode. In order to assess the target success of the procedure, a one-month follow-up MRI was performed to evaluate the ablation area. Three months later, a CT study was performed to evaluate bone mineral density to exclude structural bone abnormalities that the treatment might have induced. Pre-and post-procedure pain and disability levels were measured using the visual analogue scale (VAS) and Oswestry disability index (ODI). A 10-point improvement threshold was set as a clinical success for the ODI score, and a 2cm improvement threshold was set as a clinical success for the VAS score. VAS and ODI scores decreased significantly compared to baseline at 3- and 12-month follow-ups. Clinical success was reached in 54/56 patients (96,5%) for pain and 54/56 patients (96,5%) for disability, exceedingly the “minimum clinically important difference”. CT-assisted targeting of the ablation zone was determined successfully in all patients. The mean operative time was 32 minutes. No immediate or delayed complications were detected. Percutaneous CT-guided intra-osseous BVA seems to be a safe, fast and powerful technique for pain relief in patients with vertebrogenic chronic LBP when the selection of patients is based on a multidisciplinary approach including both conventional nuclear medicine imaging and diagnostic radiology.
KEYWORDS: pain, spine, disc, ablation, nerve
