Basivertebral nerve ablation is a potential solution for anterior column spine pain. Dr. Olivier Clerk-Lamalice outlines a typical ablation procedure and discusses alternative approaches for challenging target locations.

The procedure generally uses a transpedicular approach with an 8-gauge introducer needle, visualized under fluoroscopy. The needle angle should ensure that the probe can later be placed in the center of the vertebral body. The basic technique is similar to that of vertebral augmentation, employing an aneural and avascular approach. A bipolar ablation probe is aimed 1-cm ventral to the posterior wall of the vertebral body to establish a safe ablation zone and avoid neural structures. The ablation is performed at 85°C for 15 minutes. It is important to ablate the nerve at the vertebral bodies both above and below the target level.

For challenging targets, such as at L5, S1, high-riding pelvis, or in cases with prior transpedicular screw placement, the goal is to take the straightest path possible, which can require the transiliac approach. 

TIMESTAMPS

00:00 - Standard Procedure Walkthrough 

05:54 - Alternate Approaches for Challenging Targets

CHECK OUT THE FULL EPISODE

BackTable MSK Ep. 13- Basivertebral Nerve Ablation 

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