Pain generated by the vertebral endplate, where bone meets disc. It does not come from the disc, the joints or a nerve.
What causes vertebrogenic pain?
- The basivertebral nerve supplies the endplates. When the endplate is damaged and inflamed, that nerve carries the pain.
- It is associated on imaging with Modic Type 1 and Type 2 changes.
- Doctors have only recognized it fairly recently. That is why many people with years of back pain have never had it considered.
What are the symptoms of vertebrogenic pain?
It usually shows up as deep, aching low back pain in the middle of the back. It is worse when sitting and bending forward. The scans usually show endplate changes but no pinched nerve. It is worth finding because it is treated differently from disc or facet pain.
Remember the general rule. Findings like this one are common in people with no pain at all. They get more common with age. A finding on a report is not a diagnosis until someone has matched it to your symptoms and your exam. See understanding your MRI report.
Bring your scan and report in and we will go through it with you. Call us or request an appointment.
What is vertebrogenic low back pain?
Vertebrogenic pain comes from the vertebral endplate, not from the disc, the facet joints or a nerve root. The basivertebral nerve carries feeling from the endplate. When the endplate is damaged, that nerve becomes a real source of pain. On imaging, it matches Type 1 or Type 2 Modic change at that level. In the clinic it shows up as deep, axial low back pain in the middle of the back. It is usually worse with sitting and bending forward. And the patient’s scan has usually been called nothing dramatic.
Frequently asked questions
Why has nobody mentioned this to me before?
It has only been well described fairly recently. It takes someone looking right at the endplates and matching them to the pain pattern.
How is this different from disc pain?
The source is the endplate and the nerve that supplies it, not the disc itself. It is a separate diagnosis with its own treatment.
The mechanism is covered in Intracept — Basivertebral Nerve Ablation.
How is it treated?
When the pain pattern and Modic changes agree, ablation of the basivertebral nerve is an established option. Diagnosis comes first.
The procedure is covered in Intracept — Basivertebral Nerve Ablation.
How do I know if this is my problem?
The mix of signs is fairly specific. It is deep low back pain in the middle, worse with sitting and bending forward. There are Type 1 or 2 Modic changes at the matching level. And other sources have been ruled out.
There is more on this in Modic Changes.
Is vertebrogenic pain different from sciatica?
Yes. Sciatica comes from a nerve root. Vertebrogenic pain comes from the vertebral endplate, where bone meets disc, and the basivertebral nerve that supplies it. It feels like deep, aching low back pain in the middle that is worse when sitting and bending forward. The scan usually shows endplate changes with no pinched nerve. That difference matters because it is treated differently from nerve, disc or facet pain.
Sources
- Conger A et al. Vertebrogenic Pain: A Paradigm Shift in Diagnosis and Treatment of Axial Low Back Pain. Pain medicine (Malden, Mass.), 2022. PubMed 35856329
- 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
- Fischgrund JS et al. Intraosseous basivertebral nerve ablation for the treatment of chronic low back pain: a prospective randomized double-blind sham-controlled multi-center study. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2018. PubMed 29423885
Hurt in an accident? Start here.
You do not need a lawyer, a police report or a referral to be seen. Bring your symptoms and we will work out the rest.
Monday–Friday, 8:00 a.m. – 4:00 p.m. Same-day appointments are often available for new accident and injury patients.