1450 - Rates of Vertebral Body Compression Fracture after Basivertebral Nerve Ablation: A Retrospective Multicenter Analysis

Objectives: Basivertebral nerve ablation (BVNA) is an established minimally invasive procedure for vertebrogenic low back pain. The procedure involves inserting a cannula through the pedicle of the affected spinal vertebral body. Numerous systematic reviews have demonstrated pain relief and functional improvement^1-5. Published safety data have generally reported low rates of serious vertebral body adverse events, but small real-world cohorts have generated conflicting fracture incidence estimates^6-11. The purpose of this study was to estimate the rate of radiographically coded vertebral compression fracture (VCF) following BVNA in a large multicenter EMR database and to compare rates between patients with and without documented osteopenia/osteoporosis.

Design: This retrospective cohort study uses the TriNetX network (102 US health systems). Patients undergoing BVNA (CPT 64628) from January 2022-August 2025 were identified. Cohorts were stratified by pre-procedure ICD-10 codes for osteopenia/osteoporosis. Primary outcome: ICD-10 coded VCF (S32.0) after BVNA. We report counts, proportions, and Wilson 95% confidence intervals (CI).

Results: A total of 2,387 patients underwent BVNA (mean age 63.7 ± 14.1 years; 48.0% female, 50.6% male). Of these, 669 patients had preexisting osteopenia/osteoporosis. Overall, 37 patients developed a post-procedure VCF (37/2,387 = 1.55%; 95% CI, 1.13%-2.13%). Among patients with osteopenia/osteoporosis, 31/669 sustained a VCF (4.64%; 95% CI, 3.28%-6.50%), compared with 6/1,636 without osteopenia/osteoporosis (0.37%; 95% CI, 0.17%-0.80%).

Conclusions: Rates of compression fracture after BVNA are low, even for patients with diagnoses of osteoporosis.
In this large multicenter cohort, the overall incidence of coded vertebral compression fracture after BVNA was lower (≈4.6%) in patients with osteopenia/osteoporosis than in those without (≈0.4%). These statistically significant findings support the importance of careful pre-procedure bone-health assessment and counseling in patients with reduced bone density, suggesting the utility of future prospective studies to determine causality and optimal risk-mitigation strategies.