May 2023
Vertebrogenic Pain and the Intracept Procedure
The Path to Back Pain Relief Starts by Finding the Specific Cause
One often overlooked cause of back pain is damage to the spine’s vertebral endplates. This is often commonly referred to as vertebrogenic pain. In this article, we’ll look at vertebrogenic pain along with one of the treatments for it that has been successful for appropriate patients.
Finding the Specific Cause of Low Back Pain
Chronic low back pain is a common symptom across a diverse range of causes and medical conditions. Doctors have long understood that getting the diagnosis right is essential to select the most appropriate treatments. When therapies can be specifically targeted, rather than generalized, they have the potential to work far more effectively. But getting the diagnosis right can be a challenge.
In 1966, the authors of an article in the British Medical Journal reported that the source of chronic low back pain could not be identified in 79% of male and 89% of female patients. Zeroing in on the most effective targeted treatment back then was often elusive. We’ve come a long way since that time.
In the intervening decades, we’ve had major advances in imaging with magnetic resonance imaging (MRI) and computerized tomography (CT) – the latter also known as CAT scans. Our knowledge of spine biochemistry, biomechanics, and pathophysiology has also evolved significantly. All of this has enabled doctors to use far more sophisticated approaches to the diagnosis and treatment of low back pain. And with these advanced resources have come new discoveries.
Discovering a Fourth Structural Source of Low Back Pain
Until the turn of the century, low back pain was believed to originate in three structural sources in the spine: the zygapophyseal joints, sacroiliac joints, and intervertebral discs. With respect to the latter, the term “discogenic pain” has been associated with disc degeneration and internal disc disruption as a result of the aging process. This arthritic deterioration was assumed to lead to increased sensitivity and harmful stimulation in the sinuvertebral nerve of each spinal nerve – thus resulting in pain.
Sorting through the behavior of nerves continues to be a complex task for medical researchers. Our body is composed of millions to billions of nerve cells. The length of each set of nerve cells can vary from nanometers (a billionth of a meter) to meters. While there is a lot we’ve learned about nerve behavior, there remains much we’ve yet to learn.
Against this backdrop, in the late 1990s, a team of researchers identified a fourth potential source of lower back pain for some patients. This recently understood source centers on the basivertebral nerve.
The Basivertebral Nerve, Your Spine, and Vertebrogenic Pain
Your spine has 33 stacked small bones, called vertebrae, that form the spinal canal. The spinal canal is a tunnel that houses the spinal cord. Between each of those stacked vertebrae are spinal discs that provide separation and connection between each set of discs, as well as provide flexibility and cushioning with your back. They also furnish enough space between vertebrae for spinal nerves to exit the spinal cord system.
At the top and bottom of each vertebrae are vertebral endplates which serve as the interface between each vertebrae and the adjacent discs. As spinal discs deteriorate as a result of the wear and tear of everyday living, stress is produced on the vertebral endplates. With this stress the endplates may become damaged, leading to inflammation and vertebrognic pain.
Vertebrogenic Pain Versus Discogenic Pain
The low back pain symptoms from a damaged vertebral endplate are similar to that of a damaged disc. Correctly diagnosing the actual source of pain is critical as the optimal treatment paths can be different for each of these two distinct conditions. A separate set of targeted therapies are appropriate for vertebrogenic pain from those appropriate for discogenic pain.
Patients often describe the pain source for both types as being in the middle of their low back. They find the pain is made worse by physical activity, prolonged sitting, and bending forward, or with bending and lifting.
So how do physicians determine if a patient has vertebrogenic pain? They use MRI to look for specific changes that occur with vertebral endplate inflammation, called Modic changes.
Modic Changes
They’re called “Modic changes” because in 1988, Dr. Michael Modic was the first to publish on identifying and classifying degenerative endplate and marrow changes surrounding a dehydrated intervertebral disc. There were three types of bone marrow changes identified: Types 1, 2, and 3. Types 1 and 2 are the ones that can be used by your doctor to identify the presence of vertebrogenic pain.
The Intracept Procedure
So, if you have vertebrogenic pain, what can be done about it? One option that your doctor may consider is known as the Intracept Procedure.
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. It 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.
Unlike other nerves in the body that can regenerate, the basivertebral nerve has not shown an ability to grow back as a pain-transmitting nerve following the procedure. Clinical trials to date have shown the Intracept Procedure to provide significant improvements in function and pain at the 3-month post-surgery mark, results which are sustained more than 5 years after a single treatment1.
Evaluating Your Low Back Pain Relief Alternatives
If you are suffering from low back pain in the greater Philadelphia area, schedule your appointment to work with Main Line Spine to determine your probable causes along with a path of the most appropriate treatments for your situation. If you’d like to learn more about the Intracept Procedure, please click HERE.
NOTES
- Fischgrund J, Rhyne A, Macadaeg K, et al. Long-term outcomes following intraosseous basivertebral nerve ablation for the treatment of chronic low back pain: 5-year treatment arm results from a prospective randomized double-blind sham-controlled multi-center study. Eur Spine J. 2020;29(8):1925-34. doi.org/10.1007/s00586-020-06448-x
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