Basivertebral Nerve Ablation (Intracept Procedure)

What is the Intracept procedure (basivertebral nerve ablation) for back pain?

Basivertebral nerve ablation, also known as BVN ablation or the Intracept procedure, is a proprietary, minimally invasive system for treating chronic low back pain produced by Boston Scientific. This nonsurgical pain intervention heats (“ablates”) the basivertebral nerve to disrupt its transmission of pain signals from the spine to the brain.

What is the Intracept procedure vs. radiofrequency ablation?

The Intracept procedure is a specific type of radiofrequency ablation. The term “ablation” more broadly refers to a process of destroying (ablating) diseased or damaged body tissues. A tumor ablation, for example, aims to destroy cancer cells. Ablations are performed by various means, including chemicals, microwave, ice (cryoablation) or heat.

What is nerve ablation?

A nerve ablation is a form of pain management treatment. Most commonly, a radiofrequency ablation ablation (RFA) uses electricity to generate heat that destroys specific nerves – often the medial branch nerves – that transmit pain signals from the spinal facet joint. The Intracept procedure specifically targets the basivertebral nerve, which is located in the center of the vertebral bodies of the spine.

Who is a candidate for the Intracept procedure?

Basivertebral nerve ablation is used to treat vertebrogenic pain – low back pain that originates from diseased or damaged vertebral endplates. Patients who find relief with basivertebral nerve ablation often describe pain in the middle of their low back pain hat is made worse by physical activity, prolonged sitting, and bending forward, or with bending and lifting. 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.

What is a vertebral endplate?

A vertebral endplate is composed of two layers of specialized bone and cartilage nested between the bony portion of a spine vertebra (the “vertebral body”) and the soft-cushioning spinal disc. The endplate delivers nutrients to the discs and helps distribute the weight load placed on the vertebra evenly across the disc’s point of contact with the vertebra to prevent overstressing either structure.

Microfractures or other damage to a vertebral endplate causes inflammation, with the adjacent basivertebral nerves continuously delivering pain signals to the brain.

What are Modic changes?

Radiologist Dr. Michael T. Modic was the first to describe specific pathologies of the vertebral endplates and bone marrow, which were revealed by MRI. Degeneration in the spine can stress or wear down the endplates and allow disc fluid to contact and leak into the bone marrow of the vertebra. This creates a cascade of changes effects that lead to chronic low back pain. There are three discrete types of Modic changes, numbered according to their stages of progression:

• Modic Type 1 – Bone marrow becomes inflamed, and fluid accumulates (edema).
• Modic Type 2 – After the inflammation subsides, fat tissue replaces normal bone marrow.
• Modic Type 3 – Bone becomes hardened, thickened and denser (known as sclerosis).

The Intracept procedure is indicated for patients with MRIs that show features consistent with Modic Type 1 and Modic Type 2 changes. Type 3 is the most advanced and severe form and be associated with a range of symptoms including back stiffness, muscle spasms, pain and/or neuropathies (tingling, numbness) that may radiate out to the extremities or down the leg. This symptom can be mistaken for sciatica, although the sciatic nerve is not involved.

Who is not a candidate for the Intracept procedure?

BVN ablation is not useful for treating low back pain caused by problems unrelated to the vertebral endplates, such as facet joint, sacroiliac (SI joint), myofascial pain, herniated discs or cases of degenerative disc disease which have not affected the endplates.

How is the Intracept procedure performed?

Under fluoroscopic radiological guidance, a hollow tube called a cannula is inserted into the affected spinal vertebra. A radiofrequency generator probe is then maneuvered through the tube and positioned to the desired proximity of the basivertebral nerve. Receptors on the tip of the probe send radiofrequency-generated heat to ablate the basivertebral nerve and disrupt its ability to send pain signals to the brain, effectively relieving back pain.

What are the pros and cons of the Intracept procedure?

The Intracept procedure generally has more advantages than disadvantages, but it is not appropriate for every type of back pain, and it can have drawbacks.

A key advantage of this minimally invasive outpatient procedure is that it may provide pain relief that makes spine surgery unnecessary. It does not require big incisions or a long recovery time. There is no permanent implantation of a device or screws and rods that are used in spine surgery. Moreover, it does not exclude patients from getting other spine treatments in the future if needed. It is also associated with extremely low complication rates and quick recovery times.

Disadvantages: Some patients may report less significant pain relief than others. Not all insurance plans will cover the basivertebral nerve ablation given that it is a newer therapy. In addition, while there are few reported Intracept procedure side effects, it is not risk free. Complications are infrequent, but can include post-procedure infections or, more rarely, nerve damage. Overall, the safety profile of the Intracept procedure is strong, with a less than 0.3% rate of serious device or procedure-related complications reported in clinical trials.

What is the recovery time?

Intracept procedure recovery time can vary from a few days to a few weeks, although most people recover fully within two weeks. Patients return home the same day and those who experience immediate pain relief may return to light activity. In others, pain relief takes hold over a period of between two weeks and three months. Less often, a temporary increase pain may occur for a week or two from the procedure itself but, by around three weeks the treated nerves will cease to transmit pain signals. A return to sports activities or jobs involving heavy labor may require additional time.

What is the success rate?

The Intracept procedure was FDA cleared in 2016, so there is limited long-term data available to indicate its longevity. However, studies suggest that basivertebral nerve ablation is an effective, long-lasting and effective way to reduce back pain. A recent five-year follow-up study monitored 249 patients treated with the Intracept Procedure across three clinical trials (an average of 5.6 years for each patient). Roughly two-thirds of patients said their pain was reduced by 50% and roughly one-third of patients were 100% pain free. In addition, 70% of patients were able to resume the activity level enjoyed prior to onset of low back pain.

Posted: 3/14/2025

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