San Diego Health - Spring 2024


New Surgery Burns Away Back Pain

 Whether it’s a sharp, sudden pain or a constant dull ache, chances are you’ve experienced some type of lower back pain. One of the most common medical complaints in the U.S., back pain affects up to eight out of 10 people. In most cases, the pain goes away on its own with rest, physical therapy and medications.

For some, however, the pain becomes chronic, persisting for three months or more, and often interfering with everyday activities. Spinal injections may help temporarily, but the pain often returns. Spinal fusion surgery, which joins the affected segments of the spine to help reduce the pain, has variable success rates, as well as the risk of long-term complications. “Among our chronic back pain patients, a subset has historically been exceptionally difficult to treat,” says Kevin Barrette, MD, a Scripps Clinic physiatrist and interventional pain specialist. “These patients are likely not getting better because of what’s called vertebrogenic pain, caused by damage to their vertebral endplates.” Vertebral endplates are the protective barriers located between your vertebrae (the bones of your spine) and the soft disks that cushion them. Disk degeneration caused by injury or aging can damage the endplates and irritate the tiny basivertebral nerve that passes through each vertebra and branches off to the endplates. “Over the past decade, scientists have looked into why people are getting these very specific endplate changes, called modic changes, and what supplies sensation to them to cause pain,” explains Dr. Barrette. “Could we potentially get rid of these pain signals by killing the nerve that transmits them?” The answer is yes. A new minimally invasive procedure called basivertebral nerve ablation—or BVN ablation— essentially burns away the problem. While the patient is sedated, the surgeon creates a small incision in the back and, using tiny instruments, places an electrode over the basivertebral nerve, then heats it with radiofrequency energy. “It’s essentially like a root canal for your spine,” says Dr. Barrette, who has been involved with BVN ablation from its earliest stages. “We kill the nerve, which disrupts its ability to transmit pain signals from the endplates to the brain.” The procedure takes about 60 minutes; patients go home the same day. There is really no downtime, although Dr. Barrette advises his patients to take it easy for a week or so.

BVN ablation is FDA-approved and covered by Medicare. Candidates should have pain that is only in the back (not down the leg), worsens with certain movements or sitting for a long period of time and has lasted at least six months. They should have tried rest, physical therapy, epidural injections and other nonsurgical treatments without relief. An MRI must show modic changes to vertebral endplates. Dr. Barrette estimates that 75% of patients who meet all these criteria will have at least a 50% improvement in pain. Most patients have multifactorial pain, meaning their pain is due to modic changes and other factors. Patients whose pain is caused solely by modic changes may have full relief. Like any surgical procedure, BVN ablation has some risks, but they are relatively minimal. Spinal nerve irritation can occur in up to 10% of patients and typically goes away within six weeks. “It’s really an incredible treatment that has changed the way we treat back pain patients, especially in younger patients who used to get spinal fusion surgery,” says Dr. Barrette. “And as far as we know, this nerve does not regenerate, so the relief is long-lasting.” To learn more about Scripps orthopedic services and spinal care, visit


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