What is Basivertebral Nerve Ablation? A non-surgical alternative for Degenerative Disc Disease

[@Just_MHO_thomasina]

The most interesting takeaway from this video is that the degenerative (through arthritis etc.) consequences of the bone rubbing on bone actually causes the pain. No one has ever explained that to me. Thank you!!

[@nrthfish]

I had the Intracept (brand) procedure (basilvetebral nerve ablation) done for this condition and it was extremely successful. I knew if the procedure was successful I would still have back pain from other issues, but my back pain would be significantly reduced. This was the case. I would say 60%-70% pain reduction which was life changing in my case. INsurance didn’t want to pay and made me jump through a lot of hoops, but ultimately after almost a year, they paid. I’m glad I didn’t give up.

[@Just_MHO_thomasina]

Always the best and most informative videos... look no further! I can't thank you enough for your zoom consult. It helped me sooo much. No words.. I am so grateful. Pain is debilitating! 👍🤗

[@Sklipchan]

Thank you, Dr. Su, for another very informative video. Learn something new every time. ❤

[@tetrahedralone]

Another interesting treatment on the horizon is NPGel injected into the disc. I would really like to see more on that research.

[@Paulie1232]

Doctor Brian is the bomb 💣 😊

[@Just_MHO_thomasina]

I totally agree! Why did I not find him sooner...? His zoom consult was more helpful than any other surgeons I saw in person.

[@KGPNBK]

Thanks for sharing. I've had a L4-L5 laminectomy with a disco gram. Less than 1 year later double herniated L4-L5 received bone graphed fusion. I had 8 wonderful years no pain to speak of. Now it's an everyday thing. Very limited on my standing still abilities. I have had MRI's ,CT scans, etc... basically arthritis and wearing out of joints above and below fusion. I manage without meds but I seem to have 2 to 3 episodes a year where I'm down for approximately 3 weeks due to pain and nerve issues I believe. Neurosurgeon said I will to have another fusion sometime in my lifetime. I'm trying to do my best and prove him wrong, not sure if I will but another fusion is the absolute LAST thing I want. With all that said thank you doctor for sharing your knowledge. I wish I was closer to the west coast to get your opinion on my issues. Thanks again

[@jerryrobinson7856]

✅ You hit it right on the nerve… I am seeing a pain physician today to get a second opinion for this potential procedure. Thank you for the pre-test advice I was not told. I am in Chicago. Hope your day is fantastic. Jerry

[@250essex]

I had ablasion done 3x in Boston area in 2011. It had minimal affect if any. I eventually had a lamenectomy in late 2012. I got 8 good years normal activety and learned to manage pain and care (streching, exercise, and diet) since then. While not ideal I live relatively well with occasional flare ups. Since there are always risks and no guarantee with surgery, I concider a fusion a last step. Ablasion is definitley worth a try, the procedure is minimal, I just wanted to address expectations.

[@Just_MHO_thomasina]

Through a zoom consult it was interesting to know that it is actually the bone rubbing on the adjacent bone that causes the pain. No one ever told me that before. Be well!

[@calshepherd3659]

What happened after 8 yrs? Your age also plays a part?

[@250essex]

​@@calshepherd3659 In those 8 years I sold off my construction business and home, split my time golfing in SC, teaching skiing in Park City, UT for my 22-28 year, and living in Chiang mai Thailand. Before the surgery I had a lot more active life. Doc said if I slowed down the laminectomy would last 10 years. It's been 12 and with more management I will continue this way. 4 years ago I fully retired from teaching skiing, now full time Thailand playing golf. I'm 68 no complaints, just trying to stay healthy and enjoy life. Everyone's back problems are unique. What kind of shape you are in, tolerance to pain, the specific way your back is wearing out all play a part. If you have back problems I wish you success in dealing with it. Best wishes.

[@ramonaidu9701]

Not all ablation is the same. You likely had medial branch radiofrequency ablation. This is basivertebral nerve radio frequency ablation, which was commercialized in the US in 2017. Unliked medial branch RFA, which wears off after 6-18 months, this is a "permanent" solution. As far as we know, it works indefinitely.

[@Old_Sailor85]

Many family members have had ablation, numerous "injections", spinal fusion, and on, and on. For the most part, they were all unsuccessful. I have had back issues my whole life, since a pre-teen. I'm now 64. No surgery, no nothing. Compared to my family members, I'll put up with the issues. Those that have had "treatment" are all worse off than I am.

[@dans9228]

Thank you very much for this great educational video.

[@johnmarlon6916]

Beats the heck out of a triple level cervical fusion. Any procedure that is deemed minimally invasive is a good place to start.

[@Jo67983]

Having ablation every 6 months for 3+ years now as well as spinal stim , severe osteoporosis, arthritis. Took Medicare years to approve the laminectomy years ago. There all other modalities yet our medical insurance system is more focused on profit.

[@KC-dh5wp]

Hi Dr. I have now seen four different neurosurgeons for extremely degenerated L5S1/ Modic 2. They all pretty much tell me to try to manage pain and avoid surgery. However, it’s gotten to the point where I can barely move and am in debilitating pain 24 hours a day. I’m 38, which seems too early to barely be making it through the day without collapsing in pain. The surgeon I saw today recommended ablation, but I’m worried it will just mask the pain as the underlying issue gets worse. What are your thoughts? Thanks! Kevin

[@DrBrianSuTheSpineGuy]

You may be a good candidate for ablation. You can call 415-925-8200 for a second opinion

[@harleygirlva]

I've had ablation, epidural, cortisone, shots an procedure and not I've got extra bone growth on my facet joints an I'm miserable what can I do also have a blackened disc 😢

[@tendervittlesdoobiestein2145]

They did a preliminary test on me to see if I would respond to ablation and it failed. Still looking for less-invasive interventions than fusion.

[@Vantage-o2d]

What medications can help with this type of pain? PT is always helpful but nerve ablation is very uncomfortable and painful. Mine was not successful.

[@Konsty25]

Great video Doc, I have severe disc collapse with mild modic type 1 at l5s1. Moderate stenosis. Ive watched a lot of your videos. What about vacuum disc phenomenon?(i have this as well) Is that usually a good indicator for a fusion?

[@DrBrianSuTheSpineGuy]

All that means is air within the disk space. You really need to look at how much modic change there is. You are probably a candidate for basivertebral ablation

[@Konsty25]

​@DrBrianSuTheSpineGuy Thank you for the response ... not much back pain. Mainly burning pain in the butt and numb and tingly heels. Sometimes pain in the back of my thighs

[@chadcobanovich6509]

I just had a lumbar spine MRI. Is there any way to send it to you?

[@DrBrianSuTheSpineGuy]

You can call 415-925-8200 for a second opinion

[@justkidding9751]

More procedures and butchery that will just mask the problem and will definitely come with issues. As a sufferer myself of disc degeneration I feel it would be Better to take Hyaluronic Acid and Glucosamine Sulphate to replenish the disc's. Rather than putting yourself under the knife and trust another butcher. My last surgery didn't go well as you can tell, I lost all faith in doctors.

[@DrBrianSuTheSpineGuy]

There is no clinical outcome studies to show that hyaluronic acid and glucosamine replenish the disc.

[@ToddDouglasFox]

For 30 years we have effectively treated DDD with prolo/PRP. This includes nerve pain. Surgery, ablation, PT, and steroid injections are not on the forefront of treating failing joints. Locate an experienced prolo physician in your area, who also does PRP, for a consult if you have any back or other joint issues.

[@DrBrianSuTheSpineGuy]

From a clinical trial standpoint there are no good studies to show that PRP works for disc degeneration. There are some weak studies that show that it works for dark disc and high intensity zones. We are still looking for good research for disc degeneration and pro

[@ToddDouglasFox]

@ where are you located? If you give me your email, I’ll invite you to see what NOT PRP alone does for DDD but prolo/PRP.

[@janicenordlund2714]

What would you do for a patient with adjacent segment disease? I had a double fusion back in 2014 with no problem until 2024. I really dont want another fusion.

[@DrBrianSuTheSpineGuy]

It depends on what the disease is at the adjacent level. Meaning, is it nerve compression, disk degeneration, facet disease, etc. You can call 415 925-8200 for a second opinion appointment with me

[@FrancesHanna-g8u]

Had fall during chemo 22 L4 fell inward can Ablation help now?

[@Scott-cu4ol]

How is this different from Intercept? I recently had the intercept procedure. it help but only about 50%

[@DrBrianSuTheSpineGuy]

It is the identical procedure

[@randyhalvorson5830]

Can this procedure be done post-fusion?

[@DrBrianSuTheSpineGuy]

It's a good question. Usually with a fusion the disc is no longer an issue because of the fusion. The issue is typically the disk above or below. Patients can get this procedure if there is vertrbrogenic change above or below understanding that you would have to take the pedicle screws out first because there's no other way to get to the disk space other than through the pedicle for the bone below the disk space in question

[@e-spy]

four surgeons across the country have said "urgent surgery needed or I will end up quad" that was two years ago. You can't undo a disk removal. My surgeries were canceled due to a very high blood pressure, but now? Yeah, it's still high (seems the drugs don't work for me), but isn't it better to NOT have body parts removed? And several posters say this is a temporary fix. yeah, no. I don't want to spend the rest of my life in pain and in an operating room. Thanks, but no thanks.

[@stanleypoe7393]

After eight (8) spinal surgeries, I have always been relugated to come back to relying on medication (now Tramadol) for [some] relief! A few procedures have helped noticeably; but overall not~ I am "up to nearly any procedure" and to become a "trial case" for [even] the most radical "tries" out there~

[@fw1421]

Figures the insurance company would deny the procedure.

[@Dr.Pepper001]

I have had 2 Rhizotomies done which did not relieve my lower back pain. Then I had an Anterior Back Fusion, and that did not help, either. That was followed by 15 injections under live x-ray. I have tried every arthritis medication out there with no relief. I am now 78 and spent all day in bed every day for the padt 6 years. I have no life. Life has become meaningless.

[@jeremylockey3220]

Is nerve ablation used for cervical problems?

[@DrBrianSuTheSpineGuy]

Please look at the video on cervical facet joint syndrome or ablation for facet joints are discussed. There's currently no way to do a basivertebral ablation for the cervical spine

[@LouisWilen]

@@DrBrianSuTheSpineGuy Thanks. I had the same question.

[@codymiller510]

"hang upside-down with a weight!!?"

[@joewilliams4142]

18 years ago, I had the discogram, I told them it WAS causing the desired pain but in the wrong place. ( which seemed to me to say they were focusing on the wrong disc. L5/S1…they insisted it was the one and fused it. That did NOT help and in fact made it worse. Today, many years later, I live with daily pain, and have to reply on meds. I’ve had all kinds of injections, PT, bla bla bla….but still have the pain 24/7… Very disappointed and will never trust these kinds of specialists again.

[@DrBrianSuTheSpineGuy]

There is a difference between a provocative discogram which causes pain and an anesthetic discogram which takes away pain. Provocative discograms have not been shown to be as predictive of outcome of surgery.

[@HeyIntegrity]

So if the cause of pain is a stable chronic anterior wedge compression fracture do they inject the vertebrae directly instead of this procedure or what do they do? And since this is a nerve ablation does it have risk of multifidus weakness like face blocks might?

[@DrBrianSuTheSpineGuy]

This is not meant to treat fractures

[@Vantage-o2d]

But hurts like heck

[@walkinlove930]

The dulling of the nerves is dangerous because pain serves as a warning signal that something is wrong. If you numb or cauterize the nerves, you won't feel any pain and may not realize there's a problem until it's too late. These are just my thoughts on the matter; I'm not a professional.

[@pablopolski1228]

There is some subjective interpretation of anesthetic discogram. False positive and negatives occur and is not free of complications including discitis. I performed these for years.

[@DrBrianSuTheSpineGuy]

That is absolutely correct. It's not a perfect science although the literature does suggest that outcomes of surgery correlates well with functional anesthetic discogram.

[@Call2WakeUp]

It helps , but the nerves always grow back and reroute

[@georgespiese7388]

Why would i want to degenerate my spine? Sheesh!

[@urbugnmetoday3183]

Anyone that is given an option for a prosthetic disc, do not do it. Mine started getting bad after about five years…now nerve pain , spasms , and whatever it is when I get stuck consume my every hour with no doctor really wanting to operate

Quack

Especially you.