The basivertebral nerve has gained recognition over the past decade as a source of vertebrogenic pain. Dr. Olivier Clerk-Lamalice explains both the anatomy of the nerve and his treatment algorithm for basivertebral nerve ablation.

The basivertebral nerve is intraosseous, non-myelinated, and located in the central portion of the vertebral body within the basivertebral canal. It does not regenerate after ablation. This nerve transmits afferent pain signals to the central spinal cord, and MRI is the primary diagnostic tool used for evaluation.

During the physical exam, back pain originating from the anterior column is assessed through maneuvers such as sitting at a 15-degree angle, bending forward, and experiencing vibrations from car or plane travel. MRI findings are reviewed for Modic changes: Type 1, characterized by edematous endplates, is highly correlated with pain, while Type 2 shows early and later changes, with early changes generally being less painful.

To confirm that a patient will benefit from basivertebral nerve ablation, an anesthetic discogram is performed to identify the specific disc level causing pain. Dr. Clerk-Lamalice performs the discogram for every patient, and improvements are tracked based on patient-reported pain scores.

TIMESTAMPS

00:00 - Basivertebral Nerve Anatomy and Vertebrogenic Pain

04:15 - Modic Type 1 and 2 Definitions

05:51 - Utility of Anesthetic Discograms 

CHECK OUT THE FULL EPISODE

BackTable MSK Ep. 13- Basivertebral Nerve Ablation 

https://www.backtable.com/shows/msk/podcasts/22/genicular-nerve-ablation