Patients with chronic low back pain can suffer for many years, trying different therapies to relieve their pain. In the past, patients were often diagnosed with discogenic pain or spinal joint pain (originating from the disc or spine joints) – and treated with a course of care that focused on the joint or disc. However, research over the past several years has shown that for many patients with chronic lower back pain, their pain is actually vertebrogenic (originating within the vertebrae) and not discogenic. The type of vertebrogenic back pain that is the culprit in most cases of chronic low back pain is called vertebral endplate nerve dysfunction.
What are vertebral endplates?
Vertebral endplates consist of a layer of cartilage and a layer of porous bone. They are located between vertebrae or the bones of the spine, as well as intervertebral discs or the structures that cushion and protect the vertebrae. Vertebral endplates are the layer of protection between the bones (vertebrae) and the softer discs of the spine.
Unfortunately, vertebral endplates can become damaged over time. Damage in the endplates may allow the soft spinal disc material to enter the vertebra itself, which can cause inflammation. As a result, the basivertebral nerve, which is found within the vertebra, becomes sensitized when the endplates are damaged. When it senses inflammation, the nerve transmits back pain signals from the vertebra to the brain. This type of pain is known as vertebral endplate nerve dysfunction.
How is vertebral endplate nerve dysfunction diagnosed?
The root cause of your back pain can be diagnosed with an MRI. If the pain you’re experiencing is a result of vertebral endplate nerve dysfunction, the MRI will show any swelling in the spine bones referred to as Modic changes. If your MRI shows these Modic changes, you may be a candidate for treatment with a procedure known as Intracept that uses radiofrequency energy to desensitize the nerve that is transmitting pain signals. Unlike other nerves in the body, the basivertebral nerve does not regenerate or grow back. This means that repeat procedures would not be necessary. Most patients who undergo the Intracept basivertebral nerve ablation procedure report that their pain continues to improve over time and the majority report 75 to 100 percent pain reduction five years after the procedure. Of the patients treated at Mather Hospital with chronic low back pain and MRI proven Modic changes, over 76 percent reported relief.
David J BenEliyahu, DC, FICC, DABPM, Administrative Director, Back and Neck Pain Center at Mather Hospital.
Brian Durkin, DO, Medical Director, Pain Institute of Long Island.