Chronic low back pain (CLBP) is one of the most common musculoskeletal conditions, affecting millions of people worldwide, with some experiencing persistent pain for months or even years. Despite taking medication, undergoing physical therapy, or getting adequate rest, the pain may not improve—impacting work, daily activities, and overall quality of life.
Many people assume that back pain is simply a result of age-related degeneration or muscle inflammation. In reality, chronic low back pain can sometimes originate from structures within the vertebral body itself, which is a root cause that cannot be effectively addressed through medication alone.
Today, a minimally invasive treatment option known as basivertebral nerve ablation (BVNA) is available. It targets and disrupts pain signals transmitted from the spine, offering relief for patients with chronic low back pain who have not responded to conventional treatments.
What Is Basivertebral Nerve Ablation??
Basivertebral nerve ablation (BVNA) is a minimally invasive procedure for treating chronic low back pain. It uses radiofrequency energy to ablate the basivertebral nerve—the nerve responsible for transmitting pain signals from the vertebral body to the brain.
Historically, chronic back pain was primarily attributed to disc herniation, joint dysfunction, or muscle inflammation. However, current medical research has shown that the vertebral endplate—the interface between the vertebral body and the intervertebral disc—can also be a significant source of chronic low back pain.
When the vertebral endplate becomes inflamed or degenerates, it stimulates the basivertebral nerve to continuously transmit pain signals, resulting in persistent low back pain that may not improve despite medication, physical therapy, or other conventional treatments.
How Is RFA Different from BVNA??
There are two commonly used methods for treating chronic back pain through nerve ablation today:
- Radiofrequency Ablation (RFA): Nerve ablation using radiofrequency waves.
- Basivertebral Nerve Ablation (BVNA): Ablation to destroy nerves that transmit pain signals from the spine.
Although both procedures use radiofrequency energy for treatment, they differ in several aspects as follows:
| Feature | Lumbar Medial Branch RFA | Lumbar BVNA |
| Target Nerve | Small nerves outside the vertebral body | Basivertebral nerve inside the vertebra |
| Pain Source | Facet joints or sacroiliac (SI) joints | Vertebral endplate (Vertebrogenic pain) |
| Diagnosis Method | Requires a diagnostic nerve block injection | Clinical history, physical exam, and MRI (Modic changes) |
| Primary Indication | Joint degeneration or joint inflammation | Vertebral body pain pathways |
Although both methods share the common goal of reducing chronic back pain, selecting the appropriate procedure depends on the specific cause and characteristics of pain in each individual patient. Evaluation by a specialist along with radiological imaging is therefore crucial for planning targeted treatment that addresses the root cause to achieve the optimal outcome.
Who Is a Candidate for BVNA?
Suitable candidates for Basivertebral Nerve Ablation (BVNA) are typically patients suffering from chronic axial low back pain lasting longer than 6 months who have not responded to conservative treatments, such as medications, physical therapy, or therapeutic exercise, for at least 6 consecutive months.
Who May Not Be Suitable for BVNA?
The following individuals may not be appropriate candidates for BVNA:
- Patients with a systemic infection or infection at the spinal site
- Pregnant women
- Patients whose skeletal growth is not yet complete
- Patients with severe cardiac or pulmonary disease, which may increase procedural risk
- Patients with bleeding disorders or coagulation abnormalities
- Patients with a pacemaker or certain implanted electronic devices
- Patients who have previously undergone spinal surgery with metallic instrumentation or fixation hardware at the intended treatment site
- Patients in whom critical neural structures are located in close proximity to the planned ablation zone, which may increase the risk of injury to surrounding tissue
It should be noted that the presence of any of the above conditions does not necessarily disqualify a patient from receiving BVNA. The physician will assess each case individually, weighing the potential benefits against the risks, to ensure that every patient receives the safe and appropriate treatment for their specific situation.
The BasivertebralNerve Ablation Treatment Procedure
BVNA is performed as an outpatient procedure by a specially trained physician. It is both safe and precise, taking approximately 60–90 minutes depending on the treatment level. The procedure is carried out as follows:
- The patient lies face down on the procedure table and receives local anesthesia along with a sedative administered by an anesthesiologist to ensure comfort throughout the procedure.
- The physician inserts a needle and injects contrast dye, using real-time fluoroscopic (X-ray) guidance to confirm precise needle placement.
- A radiofrequency probe is then advanced to the target nerve, and controlled thermal energy is delivered to interrupt pain signal transmission—without affecting the motor nerves responsible for movement.
Self-care After the Procedure
Patients are able to return home on the same day. It is recommended that they gradually resume activities according to their comfort and physical capacity.
Care during the first 24–48 hours
- Patients should rest and avoid heavy lifting, twisting, and high-impact exercise for one to two weeks.
- Light walking may resume the following day.
- The wound should be kept dry; the dressing may be removed the next day, or 24 hours after the procedure.
- Soaking in a bathtub, swimming pool, or hot tub should be avoided until the wound has fully healed.
- Temporary increases in pain or soreness in the early post-procedure period are normal. Applying a cold pack for 10–15 minutes every 2–4 hours and taking over-the-counter pain relievers such as paracetamol, or other analgesics as directed by the physician, can help manage discomfort.
For long-term recovery
- Pain reduction may take approximately 3–6 weeks, as the targeted nerve requires time to fully respond to treatment.
- For patients with pre-existing mobility limitations, the physician may recommend beginning physical therapy approximately 3–4 weeks after the procedure to help restore muscle strength and flexibility.
- A follow-up appointment is generally scheduled 10–14 days after the procedure to assess recovery and monitor treatment progress.
TreatmentOutcomes
Most patients begin to notice improvement in their back pain within 3–6 weeks following the basivertebral nerve ablation procedure. Clinical studies have demonstrated that BVNA treatment outcomes can be sustained for at least five years, with some patients experiencing continued benefit beyond that period. This helps reduce pain, improve daily functioning, and decrease the need for additional treatments in the future.
Risks andComplications
Basivertebral nerve ablation is a procedure with a low rate of serious complications, and patients typically tolerate it well. However, as with any procedure involving needle insertion, certain risks should be noted.
Common, temporary side effects:
- Soreness or discomfort at the procedure site.
- A temporary increase in back pain shortly after the BVNA treatment.
- Mild local discomfort around the wound.
Less common but clinically significant complications:
- Infection.
- Bleeding at the procedure site.
- Nerve injury.
- Allergic reaction to materials or devices used during the procedure.
Overall, serious complications from BVNA are rare, and most patients recover well. Patients are encouraged to discuss the potential benefits and risks with their physician prior to undergoing treatment.
Back Pain Care at Bangkok Interventional Clinic
If you have been experiencing chronic back pain for several months, and have tried medication and physical therapy without improvement, you should not wait until the condition worsens. Let Bangkok Interventional Clinic, a clinic specializing in Interventional Pain Management, help manage your pain. (Interventional Pain Management) ช่วยดูแลอาการปวดของคุณ
The clinic is led by Assoc. Prof. Dr. Marvin Thepsoparn and a group of medical professionals from Chulalongkorn Hospital. We focus on in-depth treatments specifically tailored to each individual's physical needs.
- All patients are evaluated and treated by a board-certified pain specialist, ensuring accuracy, safety, and effective care.
- Utilizes targeted pain interventions to help reduce symptoms in a timely manner.
- Provides guidance to patients to collaboratively plan sustainable self-care.
For the basivertebral nerve ablation (BVNA) program at Bangkok Interventional Clinic, the treatment fee is 580,000 THB (subject to the patient's physical condition and the physician's assessment). You can schedule an appointment for a medical evaluation or contact us for further information at +66 93-392-3992 or LINE OA: @bicpain. Our clinic staff are ready to provide helpful recommendations.
However, the treatment outcomes depend on individual patient responses and should be evaluated by a specialized physician prior to receiving treatment.
Summary
Chronic low back pain that has not responded to normal treatments for over six months may originate from inflamed or degenerated vertebral endplates. These changes can stimulate the basivertebral nerve to transmit continuous pain signals. Basivertebral nerve ablation (BVNA) directly addresses this source of pain, unlike RFA, which treats pain originating from joints outside the bone. A large majority of patients begin to experience improvement within 3 to 6 weeks, and the procedure carries a low rate of severe complications. However, appropriate treatment depends on the underlying cause and individual symptoms, so a thorough evaluation by a specialist is highly recommended before making a treatment decision.
Frequently Asked Questions (FAQ)Frequently Asked Questions
What is Basivertebral Nerve Ablation (BVNA)?
BVNA is a minimally invasive, outpatient procedure that uses radiofrequency energy to ablate the basivertebral nerve inside the vertebral body—the nerve responsible for transmitting chronic back pain signals caused by vertebral endplate degeneration (Modic changes).
Who is a good candidate for BVNA treatment?
BVNA is suitable for adults with chronic axial low back pain lasting more than six months who have not responded to at least six months of conservative treatment (medication, physical therapy, exercise), and who show Modic changes on MRI.
How long does the BVNA procedure take?
The procedure is performed as an outpatient and takes approximately 60–90 minutes, depending on the number of levels treated. Patients can return home the same day.
When will I feel pain relief after BVNA?
Most patients begin to notice improvement within 3–6 weeks after the procedure. Clinical studies show results are maintained for at least 5 years, with a mean follow-up of 6.4 years in the long-term trial.
BVNA safe? What are the risks?
BVNA has a low rate of serious complications. Common temporary side effects include soreness at the procedure site. Less common risks include infection, bleeding, or nerve injury. Your physician at Bangkok Interventional Clinic will review all risks with you before treatment.
References
The information in this article is based on peer-reviewed clinical evidence, including:
- Fischgrund JS et al. (2018). Intraosseous basivertebral nerve ablation for the treatment of chronic low back pain: a prospective randomized double-blind sham-controlled multi-center study. Eur Spine J, 27(5), 1146-1156.
- Fischgrund JS et al. (2020). Long-term outcomes following intraosseous basivertebral nerve ablation: 5-year results. Eur Spine J, 29(8), 1925-1934.
- Smuck M et al. / INTRACEPT Trial (2021). Prospective, randomized, multicenter study of intraosseous BVNA for chronic low back pain: 12-month results. Reg Anesth Pain Med, 46(8), 683-693.
- Sayed D et al. (2022). Best Practice Guidelines: BVNA for vertebrogenic pain, ASPN. J Pain Res, 15, 2801-2819.
