Intracept — Basivertebral Nerve Ablation

Intracept treats a specific cause of chronic low back pain that most care never touches. That cause is pain made by the vertebral endplate itself.

What pain does the Intracept procedure treat?

For years, chronic low back pain has been blamed on discs, facet joints, the sacroiliac joint or muscles. Vertebrogenic pain is a fifth source. It is damage and inflammation at the endplate, where bone meets disc at the top and bottom of each vertebra.

The endplates are fed by the basivertebral nerve, which runs into the middle of the vertebral body (the main block of bone). When the endplate is damaged, that nerve carries the pain. No injection into the disc, the facet joints or the epidural space reaches it.

How do you know if your back pain is vertebrogenic?

The sign on imaging is Modic Type 1 or Type 2 endplate changes on MRI at the painful level. Type 1 means inflammation and edema (fluid) in the bone marrow. Type 2 means the marrow has turned to fat. Both are associated with vertebrogenic pain in a way that ordinary disc degeneration is not.

The pattern that goes with it is fairly steady. It is deep, aching low back pain in the middle of the back. It is worse with sitting and bending forward. It has been there for more than six months. And the scans show endplate changes but no pinched nerve that would explain it.

Who is a candidate for the Intracept procedure?

• Chronic low back pain lasting more than six months
• Modic Type 1 or Type 2 changes at the painful level
• Pain that has not responded to at least six months of conservative treatment
• Midline, axial pain (in the spine itself), not pain that shoots down the leg
• No indication for surgery at that level

It is not for pain that shoots down the leg. It is not for pain from the facet joints. And it is not for pain without endplate changes. Picking the right patient is most of what decides 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 made through the pedicle (a bony bridge on the back of the vertebra) into the vertebral body. It is the same route used for other spine bone procedures.
3. A radiofrequency probe is moved to the basivertebral nerve inside the bone. The nerve is then ablated (shut down with heat).
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 is recovery like after the Intracept procedure?

• Soreness at the entry site and in the back for one to two weeks — this is normal and expected.
• Benefit builds over weeks. It does not show up right away. People who expect instant relief decide it has failed at the very point it is starting to work.
• No sedation is used, so most patients drive themselves home.
• There are no activity restrictions afterward. Most patients resume normal activity, including work, within two to four hours.

What are the risks of the Intracept procedure?

Risks specific to this procedure come first. It is done 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 main risks are those of working inside bone: a vertebral fracture, or infection within the vertebral body. Both are uncommon. Because the basivertebral nerve does not grow back the way medial branch nerves do, the treatment is usually not repeated at the same level. Patients with active infection, significant osteoporosis at the target level, or an implanted pacemaker need a one-on-one review.

To find out whether this applies to you, call or text us. We are at 12174 Natural Bridge Rd, Suite 110, St. Louis, MO 63044.

How we judge whether it worked

The rules for who qualifies are unusually strict for a pain procedure. That strictness is why it works when it is used the right way. It needs Modic Type 1 or Type 2 endplate changes on MRI at the painful level. It needs chronic midline low back pain of at least six months. And it needs failure of conservative care (non-surgical treatment such as therapy and medicine).

Because the nerve does not grow back, the result is judged over months. It is not expected to fade. That is a real difference from facet ablation, and it changes how the choice is weighed.

Sources

• Khalil JG et al. A prospective, randomized, multicenter study of intraosseous basivertebral nerve ablation for the treatment of chronic low back pain. The spine journal : official journal of the North American Spine Society, 2019. PubMed 31229663
• Khalil JG et al. Intraosseous basivertebral nerve ablation: A 5-year pooled analysis from three prospective clinical trials. Interventional pain medicine, 2024. PubMed 39758714
• Sayed D et al. Best Practice Guidelines on the Diagnosis and Treatment of Vertebrogenic Pain with Basivertebral Nerve Ablation from the American Society of Pain and Neuroscience. Journal of pain research, 2022. PubMed 36128549
• Huang J et al. Basivertebral Nerve Ablation. Seminars in interventional radiology, 2022. PubMed 35782000