BASIVERTEBRAL NERVE ABLATION FOR VERTEBROGENIC CHRONIC LOW BACK PAIN: CURRENT EVIDENCE AND CLINICAL IMPLICATIONS

Abstract

Chronic low back pain (CLBP) is one of the leading causes of disability worldwide and represents a major clinical challenge in anesthesiology and pain medicine. While discogenic and facetogenic mechanisms have traditionally dominated diagnostic paradigms, increasing evidence supports vertebrogenic pain as a distinct entity mediated by the basivertebral nerve (BVN), particularly in patients with vertebral endplate degeneration and Modic type I or II changes on magnetic resonance imaging.

The aim of this review is to summarize current knowledge on vertebrogenic pain pathophysiology, the anatomical and biological role of the BVN, and the clinical evidence supporting basivertebral nerve radiofrequency ablation (BVN RFA) as a treatment option for chronic low back pain.

A narrative review of randomized controlled trials, prospective cohort studies, and systematic reviews was performed, focusing on clinical efficacy, durability of outcomes, safety profile, and patient selection criteria. Available evidence demonstrates clinically meaningful and sustained reductions in pain intensity and disability following BVN ablation in appropriately selected patients, with benefits persisting for several years and a low incidence of serious adverse events.

Basivertebral nerve ablation represents a promising minimally invasive intervention for vertebrogenic CLBP and may expand therapeutic options available to anesthesiologists and pain specialists. Further independent studies are needed to refine patient selection and confirm long-term outcomes.