1429 - Intracept Interception: Breakthrough Low Back Pain Relief via Basivertebral Nerve Ablation

Refractory Lumbosacral Radiculopathy (Secondary to Lumbosacral Spondylosis)

Case Description: The patient is a 56-year-old female with a 3-year history of non-traumatic chronic low back pain and right leg radiculopathy, worsened by forward flexion and limiting activity. Exam showed positive slump and straight leg raise tests, with paraspinal and sacroiliac tenderness. Imaging revealed severe right foraminal encroachment at L5-S1 compressing the right L5 nerve root and Modic type 2 changes. Acetaminophen, duloxetine, and gabapentin provided minimal relief. She had no improvement with transforaminal epidural steroid injections or a medial branch block, which yielded only 40% relief. She then underwent Intracept at L5-S1, resulting in near-complete pain relief and resumption of physical therapy.

Discussions: The 2018 SMART trial introduced intraosseous basivertebral nerve ablation (BVNA), known as the Intracept procedure, for chronic low back pain. In this randomized trial, 147 patients underwent Intracept and were compared to a sham group. At 3 months, the treatment group showed a significant 20.5-point reduction on the Oswestry Disability Index versus baseline.¹ Pooled analyses from multiple BVNA trials found that patients undergoing BVN RFA were more likely to reduce opioid use, received fewer post-procedure lumbar steroid injections, and had lower rates of lumbar fusion compared to controls—effects sustained up to five years post-procedure.²

Conclusions: Intracept has demonstrated significant pain relief in patients with chronic low back pain. This case highlights failure of multiple prior treatment modalities, with Intracept ultimately yielding substantial pain reduction and high patient satisfaction. For this patient, the time from initial presentation to BVNA was 15 months. Current guidelines recommend at least 6 months of conservative treatment and Modic changes on MRI prior to BVNA.³ Early recognition of vertebrogenic pain is essential. When criteria are met, timely referral for BVNA may accelerate return to activity and reduce the risk of long-term disability or progression to invasive surgery.