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Basivertebral Nerve Ablation: Novel Surgical Technique and Surgical Results of 25 Patients with 1 Year of Follow-up

Back pain, basivertebral nerve, minimally invasise spine surgery,  neurolysis, radiofrequency

Basivertebral nerve ablation (BVNA) is an emerging, novel technique aimed at treating lower back pain (LBP). We developed the novel X technique for BVNA and evaluated its safety and efficacy in a group of 25 patients followed for 12 months after the surgery.

I) Step-by step description of the X TECHNIQUE for BVNA between L2-L5, emphasizing its innovative aspects (target, system and technique) as well as its practical aspects that optimize the task flow and minimize radiation exposure.

II) Retrospective analysis of the clinical/surgical records and radiological studies of 25 consecutive and STRICTLY SELECTED patients treated with BVNA employing the X technique and followed for 12 months after the surgery.

I) Surgical technique description: C-arm guided, trans or extra pedicular,  oblique cranial-caudal access technique for BVNA  using straight/rigid catheters. 

II) Retrospective study.

The X technique: For each vertebra, on an axial CT/MRI, calculate the distance between the skin entry point and the midline drawing a line connects three points: the center of the vertebral body, the junction of the medial pedicular wall with the vertebral body and the skin. Patient in prone position under sedation or general anesthesia. Under fluoroscopy (perfect AP incidence), draw the midline and the oblique cranial-caudal trajectory connecting opposite corners of the vertebral body. Access to the geometric center of the vertebral body by sequential introduction of the needle, drill and monopolar radiofrequency catheter. BVNA with real-time and accurate control of the temperature at the geometric center and posterior wall of the vertebral body: temperature-controlled algorithm, 6 minutes, 60 degrees.

Clinical and radiological results: 25 patients. 10M/15F. Age: mean 46 (32-58). Treated vertebrae: L4 and L5. VAS improvement: mean 54/100 (33-77). ODI improvement: mean 49/100 (36-66). Opioid prescription: - 9 patients. Surgical time: mean 35 minutes (30-42). No systemic, neurologic or radiologic adverse events.

The X technique is a quick, safe and effective option for BVNA. To the best of our knowledge, this is the first study evaluating the feasibility of BVNA employing straight/rigid catheters to target the geometric center of the vertebral body. Additionally, this is one of the first non-industry funded and non-USA based studies evaluating the role of BVNA.