In brief
- Vertebrogenic pain comes from damaged vertebral endplates, identified by Modic changes on MRI, and is transmitted by the basivertebral nerve.
- This is a one-time procedure designed for long-term functional success; clinical studies show relief that can last for years.
- Expect increased deep bone pain for 3 to 10 days afterward. This is a normal response to the thermal ablation.
- Full relief develops over 2 to 6 months, with peak relief typically between 6 weeks and 3 months.
Understanding your diagnosis
Vertebrogenic pain is a specific type of chronic low back pain caused by damage or inflammation of the vertebral endplates, the area where your discs connect to the bones of your spine. While many treatments focus on the discs themselves, basivertebral nerve ablation targets the basivertebral nerve, which is responsible for transmitting pain signals from these damaged endplates. This condition is typically identified through specific Modic changes seen on an MRI.
The treatment
Basivertebral nerve ablation is a minimally invasive, clinically proven procedure designed to provide durable relief for chronic low back pain. Unlike temporary injections, this procedure involves placing a specialized probe into the vertebra to deliver radiofrequency energy. This thermal energy heat-treats the basivertebral nerve, permanently interrupting the pain signaling process. The device used reaches the nerve during the procedure; nothing external is left in place.
Our approach
Dr. Pugh uses live X-ray (fluoroscopy) to ensure the probe is positioned with sub-millimeter accuracy within the bone. This procedure is part of our commitment to innovative, evidence-based solutions that address the root cause of spinal pain for patients who have not found relief through conservative care.
Before your procedure
For your safety, certain medications must be held before your procedure to minimize the risk of bleeding, following American Society of Regional Anesthesia guidelines. This procedure requires the 24-hour NSAID hold.
| Medication type | Examples | Required hold |
|---|---|---|
| NSAIDs | Ibuprofen, Motrin, Aleve, naproxen, meloxicam | 24 hours |
| Salicylates | Aspirin, all doses | 24 hours |
| Antiplatelets | Plavix (clopidogrel), Brilinta | 7 days |
| Antiplatelets | Effient (prasugrel) | 10 days |
| Anticoagulants | Eliquis, Xarelto, Savaysa, Pradaxa | 5 days |
| Vitamin K antagonist | Coumadin, warfarin | 5 days (INR below 1.5) |
Restarting
Most medications can be restarted 24 hours after the procedure. NSAIDs and aspirin may be resumed immediately.
Fasting, sedation, and your ride home
- If you are receiving sedation, nothing to eat or drink for six hours before your appointment. Essential morning medications may be taken with a small sip of water only.
- We offer light or deep sedation. The level is decided by the physician and anesthesia team based on the procedure and clinical need.
- Any patient receiving sedation must be accompanied by a responsible adult driver to take them home.
Where to go
Procedures are performed at one of three facilities: our clinic at 1925 Hospital Place, ACOM at 6449 Central Park Blvd, or Hendrick South at 6399 Directors Pkwy, Suite 100. Your appointment paperwork tells you which one. Please arrive early for registration and pre-procedure preparation.
Procedure day
- Performed in a professional ambulatory surgery center.
- Live X-ray for exact safety and precision.
- Patients typically receive sedation for a comfortable experience.
- This is a one-time procedure designed for long-term functional success.
Benefits
- Durable relief: clinical studies show significant pain reduction that can last for years.
- Non-surgical recovery: an alternative to invasive spinal fusion or hardware-based surgery.
- Targets the source: specifically addresses endplate-related pain that other procedures may miss.
Recovery
- Standard resumption: most patients return to light activity within a day or two.
- Full relief usually develops over 2 to 6 months.
- A brief follow-up will be scheduled to assess you.
Afterward: what to expect
- The flare. Expect increased deep bone pain for 3 to 10 days. This is a normal inflammatory response to the thermal ablation. Use ice packs (20 minutes on, 20 off) and continue baseline medications.
- Results. Peak relief typically occurs between 6 weeks and 3 months.
Activity
Wound care
Your procedure in one paragraph
You have undergone a basivertebral nerve ablation, a specialized procedure designed to treat chronic back pain originating from your vertebral body (vertebrogenic pain). Using radiofrequency energy, we have cauterized the specific nerve inside your bone that was transmitting pain signals to your brain. This procedure was performed to stop those signals permanently without the need for a permanent implant or major spinal surgery.
Follow-up schedule
- 1
2 weeks
Wound check and post-operative review.
- 2
3 months
Formal functional assessment of how well the procedure worked.
Call us right away if you notice
- New or worsening leg weakness, numbness, or foot drop
- Sudden loss of bowel or bladder control
- Fever above 101.5°F, chills, or drainage at the site
- A severe headache that worsens when sitting or standing
This guide is the same information as the printed handout from Abilene Pain. It is general information and does not replace the instructions your care team gives you at your visit. Your care team: Nicolas Pugh, MD · Adrianne Anders, NP · Ted Chaka, PA.