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Looking at an Option to Relieve Vertebrogenic Chronic Low Back Pain

In appropriate situations, the Intracept Procedure presents a minimally invasive, outpatient alternative for patients with vertebrogenic pain. It is a targeted procedure to relieve that chronic low back pain. Here’s the basics.

Dr Roy Lerman

A Certain Nerve Is the Key

Vertebral endplates – found on either side of the disc – can become damaged over time, causing inflammation and back pain. The basivertebral nerve (BVN), found within the vertebrae, carries these back pain signals from the inflamed endplates to the brain.

The Intracept Procedure Can Relieve the Pain

The Intracept Procedure is a same-day procedure performed in an outpatient surgery center. Unlike some major surgeries, the Intracept Procedure is implant-free and preserves the overall structure of the spine.

The Intracept Procedure involves heating the basivertebral nerve with a radiofrequency probe to stop it from sending pain signals to the brain. Patients are under anesthesia, and the procedure generally lasts an hour.

Different from other nerves in the body that regenerate, the BVN has not shown an ability to grow back as a pain-transmitting nerve following the Intracept Procedure.

What to Expect After the Procedure

Following the procedure, your doctor may recommend some precautions to take – and after a brief recovery period, most people resume normal activities.

See if you may benefit from the procedure, and connect with an Intracept-trained Main Line Spine doctor.

Vertebrogenic Pain Is Understood

Vertebrogenic pain is a distinct type of chronic low back pain caused by damage to vertebral endplates, the interface between the disc and the vertebral body. Disc degeneration, and the wear and tear that occurs with everyday living, produces stresses on the endplates that damage them, leading to inflammation and vertebrogenic pain.

How Patients Describe Vertebrogenic Pain

The disc and endplate are both part of the anterior spinal column and produce similar low back pain symptoms. However, endplate pain is associated with distinctive changes on routine MRI called Modic changes.
Patients who find relief from the Intracept Procedure often describe pain in the middle of their low back that is made worse by physical activity, prolonged sitting, and bending forward, or with bending and lifting. (*1)

Vertebrogenic Pain Has a Clear Diagnosis

To confirm that a patient has vertebrogenic pain, physicians use MRI to look for specific changes that occur with endplate inflammation, which are called Modic changes.

Ablating the Basivertebral Nerve Is the Key

The basivertebral nerve enters through an opening in the back of the vertebral body and branches near the center of the vertebral body, sending nerves to innervate the superior and inferior endplates. These nerve endings transmit pain signals from the endplate to the brain and have been shown to increase in number with endplate damage or degeneration. (*2-4)

Learn more. See if you may benefit from the procedure, and connect with an Intracept-trained Main Line Spine doctor.

Let’s Get to It:
What the Intracept Procedure Involves

The Intracept Procedure is a minimally invasive, outpatient procedure for patients with vertebrogenic pain. The procedure targets a specific nerve within the vertebra called the basivertebral nerve and has been shown to improve function and relieve pain long-term. The procedure is implant-free, preserving future treatment options for other spine conditions.

Here’s what the procedure involves.

Step One: Access the Pedicle

Under fluoroscopic guidance, the Intracept® Introducer Cannula Assembly is advanced through the pedicle.

Step Two: Create the Channel

The Intracept® Curved Cannula Assembly is used to create a channel to the trunk of the basivertebral nerve.

Step Three: Place the RF Probe

The Intracept® RF Probe is inserted into the curved path and placed at the trunk of the basivertebral nerve.

Step Four: Ablate the BVN

The Intracept® RF Generator is used to deliver radiofrequency energy that ablates the basivertebral nerve.

Watch a Procedure Walkthrough

Walk through the steps of the procedure.

Since 1993, Main Line Spine has been the Philadelphia region’s answer

Low Back Pain

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Each patient’s spine and lower back pain issues are unique. So should be the customized path chosen to restore the quality of your life.

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Schedule an appointment with an Intracept-trained Main Line Spine doctor to see if this procedure may be appropriate for you.

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Or call (610) 337-3111 during office hours to schedule your appointment directly.

As with any surgical procedure, there are risks and considerations associated with the Intracept Procedure. See important safety information below.

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Patients: See the Indications & Risks Involved

The Intracept Procedure is indicated for patients who have had chronic low back pain for at least six months, who have tried conservative care for at least six months, and whose MRI shows features consistent with Modic changes – indicating damage at the vertebral endplates has led to inflammation.

Not every patient who meets these criteria is a candidate for the Intracept Procedure, however – in fact, there are specific characteristics indicating a patient should not be considered for the procedure. These contraindications include being pregnant, having weakened cardiac or pulmonary function, having an implanted electronic medical device in the body (such as a pacemaker or defibrillator), being diagnosed with a systemic or local infection, or having an anatomy that could be damaged unintentionally while ablating the basivertebral nerve (based on your physicians’ clinical review). The Intracept Procedure is also contraindicated in patients who are skeletally immature – which generally means individuals under the age of 18 are not candidates. There are also certain risks and precautions regarding the procedure which you should be aware of before proceeding.

Talk with your doctor about what indicates, and contraindicates, certain patients for the Intracept Procedure – as well as the risks and precautions for the procedure.

Physicians: See Indications, Contraindications, and Risks

The Intracept Procedure Intraosseous Nerve Ablation System is intended to be used in conjunction with radiofrequency (RF) generators for the ablation of basivertebral nerves of the L3 through S1 vertebrae for the relief of chronic low back pain of at least six months duration that has not responded to at least six months of conservative care, and is also accompanied by features consistent with Type 1 or Type 2 Modic changes on an MRI such as inflammation, edema, vertebral endplate changes, disruption and fissuring of the endplate, vascularized fibrous tissues within the adjacent marrow, hypointensive signals (Type 1 Modic change), and changes to the vertebral body marrow including replacement of normal bone marrow by fat, and hyperintensive signals (Type 2 Modic change).

Use of the Intracept Procedure Intraosseous Nerve Ablation System is contraindicated in:

  • Patients with severe cardiac or pulmonary compromise
  • Patients where the targeted ablation zone is < 10 mm away from a sensitive structure not intended to be ablated, including the vertebral foramen (spinal canal)
  • Patients with active systemic infection or local infection in the area to be treated
  • Patients who are pregnant
  • Skeletally immature patients (generally < 18 years of age)
  • Patients with implantable pulse generators (e.g., pacemakers, defibrillators) or other electronic implants
  • Situations where unintended tissue damage may result, based on the clinical assessment by the physician
  • Application with electrosurgical instruments NOT tested and specified for use with the Relievant RFG

As with any surgical procedure, there are risks and considerations associated with the Intracept Procedure. To review the contraindications, warnings, and precautions click here.

  1. Koreckij T, Kreiner S, Khalil JG, Smuck M, Markman J, Garfin S. Prospective, randomized, multicenter study of intraosseous basivertebral nerve ablation for the treatment of chronic low back pain: 24-month treatment arm results. NASSJ. Published online October 26, 2021. DOI: https://doi.org/10.1016/j.xnsj.2021.100089
  2. Fras C, Kravetz P, Mody DR, Heggeness MH. Substance P-containing nerves within the human vertebral body: an immunohistochemical study of the basivertebral nerve. The Spine Journal: Official Journal of the North American Spine Society. 2003;3(1):63-7.
  3. Bailey JF, Liebenberg E, Degmetich S, Lotz JC. Innervation patterns of PGP 9.5-positive nerve fibers within the human lumbar vertebra. Journal of Anatomy 2011;218(3):263-70.
  4. Lotz JC, Fields AJ, Liebenberg EC. The Role of the Vertebral End Plate in Low Back Pain. Global Spine J 2013;03:153-64.