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Clinicians
may use ablation of the BVN (basivertebral nerve) to treat patients with
vertebrogenic CLBP (chronic low back pain).
In a recent study conducted in the United States, it was found out that chronic low back pain (CLBP) patients treated with BVN (basivertebral nerve) ablation demonstrated sustained and significant clinical improvements in pain and function with high responder rates at a mean of 6.4 years following treatment.
Between October 2011 and February 2014, this single-arm, open-label, prospective study was conducted to report the 5-year clinical outcomes for patients treated with BVN ablation for vertebrogenic CLBP in the SMART (Surgical Multi-center Assessment of RF Ablation for the Treatment of Vertebrogenic Back Pain) RCT (randomized controlled trials).
A total of 117 US participants were
successfully treated with BVN ablation. After BVN ablation, patient-reported
outcomes of ODI (Oswestry disability index), VAS (Visual Analog Scale),
post-ablation treatments, and patient satisfaction were gathered at a minimum
of 5-years.
Mean change in ODI was the primary outcome
measure. Using an analysis of covariance with alpha 0.05, comparative
evaluation between the post-ablation and baseline values was done. Of the 117
participants, 100 (85%) subjects were available for review with a mean
follow-up period of 6.4 years. At a 5-year follow-up, the mean ODI score
improved from 42.81 to 16.86 (the mean reduction of 25.95 points was
statistically significant) as illustrated in Figure 1:
Figure 1: Mean ODI at baseline, and a minimum of 5 years in BVN-treated participants
The mean reduction in the VAS pain score was illustrated to be 4.38 points (baseline of 6.74). In total, 66% of participants reported a >50% reduction in pain, 47% reported a >75% reduction in pain, and 34% of patients reported complete pain resolution as depicted in Figure 2:
Figure 2: Proportion of
participants by % mean improvement in VAS from baseline to a minimum of 5 years
of follow-up
Composite responder rate utilizing thresholds of ≥15-point ODI and ≥2-point VAS for function and pain at 5 years was 75%. Thus, BVN ablation is a safe, effective, durable, and minimally invasive technique for the relief of CLBP.
European Spine Journal
Long-term outcomes following intraosseous basivertebral nerve ablation for the treatment of chronic low back pain: 5-year treatment arm results from a prospective randomized double-blind sham-controlled multi-center study
Jefrey S. Fischgrund et al.
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