Intracept — Basivertebral Nerve Ablation

Intracept treats a specific cause of chronic low back pain that most treatment never addresses: pain generated by the vertebral endplate itself.

The pain source it treats

For years, chronic low back pain has been attributed to discs, facet joints, the sacroiliac joint or muscles. Vertebrogenic pain is a fifth source — damage and inflammation at the endplate, the bone-disc interface at the top and bottom of each vertebra.

The endplates are supplied by the basivertebral nerve, which runs into the middle of the vertebral body. When the endplate is damaged, that nerve carries the pain — and no injection into the disc, the facet joints or the epidural space reaches it.

How you know it is this

The imaging signature is Modic Type 1 or Type 2 endplate changes on MRI at the painful level. Type 1 represents inflammation and edema in the bone marrow; Type 2 represents fatty replacement. Both are associated with vertebrogenic pain in a way that ordinary disc degeneration is not.

The clinical picture that goes with it is fairly consistent: deep, midline, aching low back pain, worse with sitting and forward bending, present for more than six months, in someone whose scans show endplate changes but no nerve compression that would explain it.

Who it is for

• Chronic low back pain lasting more than six months
• Modic Type 1 or Type 2 changes at the symptomatic level
• Pain that has not responded to at least six months of conservative treatment
• Midline, axial pain rather than radiating leg pain
• No indication for surgery at that level

It is not for radiating leg pain, not for facet-mediated pain, and not for pain without endplate changes. Selection is most of what determines the result.

What the procedure involves

1. You are positioned face down, and the procedure is performed under local anesthetic with live fluoroscopic guidance. No sedation is used, so you stay awake and responsive throughout.
2. A channel is created through the pedicle into the vertebral body — the same route used for other vertebral procedures.
3. A radiofrequency probe is advanced to the basivertebral nerve within the bone, and the nerve is ablated.
4. The instruments are removed. There is no implant and nothing is left behind.
5. It usually takes about an hour, and it is a day procedure.

What to expect afterwards

• Soreness at the entry site and in the back for one to two weeks — this is normal and expected.
• Benefit builds over weeks rather than appearing immediately. Expecting instant relief leads people to conclude it has failed at exactly the point it is starting to work.
• No sedation is used, so most patients drive themselves home.
• There are no activity restrictions afterwards. Most patients resume normal activity, including work, within two to four hours.

Risks

Specific to this procedure: it is performed through the pedicle into the vertebral body, so it is more involved than a facet ablation. It is still done under local anesthetic without sedation. Expect back soreness for one to two weeks. The specific risks are those of instrumenting bone — vertebral fracture, and infection within the vertebral body, both uncommon. Because the basivertebral nerve does not regenerate in the way medial branch nerves do, the treatment is generally not repeated at the same level. Patients with active infection, significant osteoporosis at the target level, or an implanted pacemaker need individual assessment.

To find out whether this applies to you, call (314) 310-5577 or text (314) 886-5902. We are at 12174 Natural Bridge Road, St. Louis, MO 63044.

How we judge whether it worked

The selection criteria are unusually specific for a pain procedure, and that specificity is why it works when it is used correctly. It requires Modic Type 1 or Type 2 endplate changes on MRI at the symptomatic level, chronic midline low back pain of at least six months, and failure of conservative care.

Because the nerve does not regenerate, the result is judged over months rather than being expected to wear off. That is a genuine difference from facet ablation and it changes how the decision is framed.