Basivertebral Nerve Ablation

Basivertebral nerve ablation technique

Chronic low back pain represents a leading cause of global disability, but can often be complex in etiology, with multiple pain generators contributing to patient discomfort. Anterior column low back pain involves the vertebral bodies and discs, with the vertebral body endplates now known to be a significant pain generator. Vertebrogenic low back pain secondary to irritation of the basivertebral nerve presents as axial discomfort, worse with forward flexion, and with concomitant Type I or II Modic changes on MRI. Minimally invasive basivertebral nerve radiofrequency ablation has emerged as an effective intervention for managing anterior column back pain. In this article, the authors present a comprehensive approach to identifying and treating vertebrogenic low back pain through image guided basivertebral nerve ablation. We outline the patient presentation and diagnostic workup, followed by a detailed procedural guide including equipment requirements, technique execution, and potential technical challenges and complications.

Applications of SPECT/CT in the Evaluation of Spinal Pathology: A Review

BACKGROUND

Accurate identification of pain generators in the context of low back and spine-related pain is crucial for effective treatment. This review aims to evaluate the potential usefulness of single photon emission computed tomography with computed tomography (SPECT/CT) as an imaging modality in guiding clinical decision-making.

METHODS

A broad scoping literature review was conducted to identify relevant studies evaluating the use of SPECT/CT in patients with spine-related pain. Studies were reviewed for their methodology and results.

RESULTS

SPECT/CT appears to have advantages over traditional modalities, such as magnetic resonance imaging and CT, in certain clinical scenarios. It may offer additional information to clinicians and improve the specificity of diagnosis. However, further studies are needed to fully assess its diagnostic accuracy and clinical utility.

CONCLUSIONS

SPECT/CT is a promising imaging modality in the evaluation of low back pain, particularly in cases where magnetic resonance imaging and CT are inconclusive or equivocal. However, the current level of evidence is limited, and additional research is needed to determine its overall clinical relevance.

CLINICAL RELEVANCE

SPECT/CT may have a significant impact on clinical decision-making, particularly in cases in which traditional imaging modalities fail to provide a clear diagnosis. Its ability to improve specificity could lead to more targeted and effective treatment for patients with spinal pathology.

LEVEL OF EVIDENCE: 4

Clinical Diagnosis and Treatment of Chronic Pain

More than 600 million people globally are estimated to be living with chronic pain. It is one of the most common complaints seen in an outpatient setting, with over half of patients complaining of pain during a visit. Failure to properly diagnose and manage chronic pain is associated with substantial morbidity and mortality, especially when opioids are involved. Furthermore, it is a tremendous financial strain on the healthcare system, as over USD 100 billion is spent yearly in the United States on healthcare costs related to pain management and opioids. This exceeds the costs of diabetes, heart disease, and cancer-related care combined. Being able to properly diagnose, manage, and treat chronic pain conditions can substantially lower morbidity, mortality, and healthcare costs in the United States. This review will outline the current definitions, biopsychosocial model, subclassifications, somatosensory assessments, imaging, clinical prediction models, and treatment modalities associated with chronic pain.