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Basivertebral Nerve Ablation for Vertebrogenic Back Pain

Basivertebral nerve ablation picture

By Mr Ahmed-Ramadan Sadek, Neurosurgeon · 12 min read

🎧 Listen to this guideAbout 8 minutes. Narrated in Mr Sadek’s voice using AI technology. General information only, not personal medical advice.

On this page

Key points

  • Basivertebral nerve ablation (BVNA) uses heat to switch off a small nerve inside the bones of the lower spine. It is aimed at one type of long-term back pain, called vertebrogenic pain, thought to come from damaged endplates: the top and bottom surfaces of the spinal bones next to the discs.
  • It is only considered for people whose back pain has lasted at least 6 months despite non-surgical treatment, and whose MRI shows particular endplate changes called Modic type 1 or type 2 changes at the matching levels.
  • NICE has not yet issued guidance on BVNA. It is assessing the procedure now, with no publication date set. NICE’s existing advice on radiofrequency denervation covers a different nerve, the medial branch nerves to the facet joints.
  • In trials, about 5 or 6 in 10 people treated reported their back pain at least halved after a year, and many still had benefit at 5 years. Only one trial compared it with a dummy (sham) procedure, and the dummy group also improved a lot.
  • Serious complications are uncommon. The main risks are a spell of leg pain, and, mainly in people with thin bones, a small chance of a fracture of the treated bone.

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Go to A&E or call 999 straight away if you have back pain together with:

  • Pain, tingling, weakness or numbness in both legs.
  • Loss of feeling around your genitals or your bottom (anus).
  • Changes in your bladder or bowels, such as difficulty peeing, or peeing or pooing yourself.
  • Changes in how your genitals feel during sex, or new problems getting or keeping an erection or reaching orgasm.
  • Chest pain, or back pain that started after a serious accident.

These apply before and after any procedure.[1] Do not drive yourself to A&E: ask someone to take you, or call 999 for an ambulance.[1] See also our warning signs page.

What is vertebrogenic back pain?

Each spinal bone (vertebra) has a flat top and bottom surface called an endplate, which sits against the disc above or below. A small nerve, the basivertebral nerve, enters each vertebra through a small opening at its back and supplies the bone and its endplates.[16][4] When an endplate is damaged or inflamed, pain signals may travel along this nerve. Pain thought to arise this way is called vertebrogenic pain.[3]

The trials of BVNA included people with pain in the lower back itself, and excluded people with nerve pain going down the leg from a trapped nerve, such as sciatica.[11]

Estimates of how many people with long-term back pain have this type vary. NICE’s project description gives about 15 in 100.[3] A US spine clinic that applied the strict entry rules of the trials found only about 3 in 100 of its patients with back pain would qualify.[18]

What are Modic changes?

Modic changes are changes in the bone marrow just next to an endplate, seen on an MRI scan. Two main types were described in a 1988 study of 474 people having a lower back MRI: type 1 in 4 in 100 and type 2 in 16 in 100. In every case the disc at that level was worn.[5] Our MRI guide explains how the scan works.

  • Type 1 looks like swelling and active change in the bone next to the endplate. In the original study, tissue samples showed cracks in the endplate and new blood vessels.[5]
  • Type 2 looks like fatty marrow. In the same study, most type 1 changes that were scanned again had turned into type 2 over 14 months to 3 years.[5]

The BVNA trials included only people with type 1 or type 2 changes.[7][11]

Modic changes are common in people with back pain, but they also turn up in people without it. A review of 77 studies found them in a median of 43 in 100 people with back pain or sciatica, compared with 6 in 100 in people not attending for back problems.[6] So a Modic change on your report is not proof that your pain comes from the endplate. It is one piece of the picture, alongside where your pain is and what makes it worse. Our degenerative disc disease guide covers related scan findings.

What happens in basivertebral nerve ablation?

The aim is to stop the basivertebral nerve carrying pain signals by heating it. It is usually a day-case procedure.[4]

  1. You lie on your front. Some units give sedation, so you are awake but drowsy; others use local anaesthetic only. In one large trial, about half of patients had sedation.[4][11]
  2. The skin and the deeper tissues are numbed with local anaesthetic.[4]
  3. A small cut of about 5 mm is made, and a hollow needle is passed under X-ray guidance through the pedicle, the bony bridge at the back of the vertebra, into the middle of the bone.[4]
  4. A probe is placed through the needle near the point where the nerve enters the bone, and the tip is heated. In the main trials the probe was heated to 85°C for 15 minutes at each vertebra.[16] One NHS leaflet says that usually only the first few seconds are painful, and sedation and pain relief are given.[4]
  5. This is repeated for each vertebra being treated. The trials treated the Modic levels between the third lumbar vertebra and the top of the sacrum, up to four vertebrae.[11] One NHS unit says at least two vertebrae are generally treated.[4]

Estimates of the time taken range from about an hour on average[3][4] to a mean of 88 minutes from cut to closure in one trial.[11]

What NICE says

NICE has not published guidance on basivertebral nerve ablation. It selected the procedure for an interventional procedures assessment in May 2023, and started scoping the work in September 2026. A final scope is planned for November 2026, and the date for the guidance is still to be confirmed.[3] Until it is published, NICE has made no recommendation either for or against BVNA.

NICE’s guideline on low back pain, NG59, does recommend considering radiofrequency denervation for some people with chronic low back pain. That recommendation is about the medial branch nerves, which supply the facet joints at the back of the spine, and it applies only after a positive diagnostic medial branch block.[2] BVNA targets a different nerve inside the vertebra, so NG59’s advice on radiofrequency denervation does not cover it. Our radiofrequency treatment for facet joint pain guide explains that procedure.

Views elsewhere differ. A US specialist society graded the evidence for BVNA as its highest level in carefully selected patients,[23] while systematic reviews describe the evidence as moderate quality and note that most studies were funded by the device company.[15][16] NICE’s assessment may come to its own view.

How well does it work?

Two randomised trials and their long-term follow-ups, all funded by the device maker, form most of the evidence.[11][16]

The SMART trial: BVNA compared with a sham procedure

In the SMART trial, 225 people with chronic low back pain and Modic type 1 or 2 changes were randomly allocated to BVNA (147) or a sham (dummy) procedure (78). The trial was double-blind, so patients did not know which they had.[7]

  • At 3 months, disability scores (the Oswestry Disability Index, ODI, out of 100) fell by 20.5 points after BVNA and by 15.2 points after the sham, among people treated as planned.[7]
  • A meaningful improvement in disability (10 points or more) was seen in about 76 in 100 after BVNA and 55 in 100 after the sham.[7]
  • The sham group improved a lot, which the authors called a large placebo response.[8] Pooling the sham comparison, one review found BVNA did better for disability, but the difference for halving pain could have been due to chance.[15]
  • After 12 months, 73 in 100 of the sham group chose to have the real treatment, so later results have no comparison group.[8]

The INTRACEPT trial: BVNA compared with usual care

In INTRACEPT, 140 people were randomly allocated to BVNA or to continue standard care, such as physiotherapy, exercise, pain medicines or injections. Everyone knew which treatment they had, which can make the treated group look better.[10][11]

  • At 3 months, disability improved by about 20 points more after BVNA than with standard care, and pain by about 2.5 points more out of 10.[11]
  • The trial was stopped early at a planned interim check because the difference was so clear, and the standard care group was offered BVNA.[10]
  • At 12 months, 64 in 100 of the BVNA group reported their pain at least halved, and 29 in 100 were pain free.[11]

Long-term results

Follow-up of the treated groups suggests benefit often lasts, although some people were lost to follow-up and there was no comparison group by then:

  • 2 years: about 72 in 100 of the INTRACEPT group who were followed up had at least halved pain, and 31 in 100 were pain free.[12]
  • 3 years: 95 people from two studies; average pain fell by 4.3 points from 6.7 out of 10, and about 73 in 100 had at least halved pain.[13]
  • 5 years and beyond: in SMART, 100 of 117 treated people were reviewed after an average of 6.4 years; 66 in 100 had at least halved pain and 34 in 100 had none.[9] Pooling three studies, 249 of 320 people were seen at about 5.6 years, and 32 in 100 were pain free.[14]
  • Further treatment: by 5 years, about 13 in 100 had needed another injection, ablation or operation for the same pain at the same level, including about 6 in 100 who had a fusion.[14]

Outside trials

Results in everyday practice may be lower than in trials with strict entry rules. In a study of 60 people treated in routine care, about 49 in 100 reported their pain at least halved after a year.[17] So estimates of the chance of halving your pain at around a year range from about 49 in 100[17] to 64 in 100.[11][16] A review that counted people lost to follow-up as failures put it at about 50 in 100 by 5 years.[16]

Who may it suit?

The trials included adults with:[11]

  • Low back pain for at least 6 months that had not improved with at least 6 months of non-surgical treatment.
  • Modic type 1 or 2 changes at one or more levels from the third lumbar vertebra down to the sacrum.
  • Moderate or severe pain and disability.

They excluded people with leg nerve pain matching a trapped nerve, symptomatic spinal stenosis, a disc bulge over 5 mm, a slipped vertebra or a stress fracture of the spine, facet joint pain, most previous back operations, thin or fragile bones or a previous fragility fracture, infection, a body mass index over 40, pregnancy, or an active implanted electrical device.[11] Results in these groups are less certain.

In Mr Sadek’s practice, every case is discussed at a multidisciplinary team (MDT) meeting before BVNA is offered. Other NHS units do the same: in one, pain specialists, spinal surgeons, physiotherapists and a radiologist review each case, and scans other than MRI (PET-CT or SPECT-CT) may be used.[4]

Before the procedure

  • Blood-thinning medicine: tell the team early. One NHS unit asks for at least 2 weeks’ notice. Do not stop it unless you are advised to.[4]
  • Implanted devices: tell the team if you have a pacemaker, cochlear implant, spinal cord stimulator or similar device.[4]
  • Bone health: tell the team about osteoporosis, thin bones or any previous fracture, as this affects the fracture risk.[20]
  • Pregnancy, infection or recent antibiotics: tell the team.[4]
  • Eating and drinking: follow your hospital’s instructions, especially if you are having sedation.[4]

Recovery: what to expect

Follow your own team’s advice. This is based on an NHS leaflet and the trial reports.[4][11]

Time afterWhat to expect
Same dayRecovery on the ward, usually home within about 4 hours. As you cannot drive, arrange a lift.[4]
First 24 hoursDo not drive for at least 24 hours; your insurance may not cover you.[4]
First weekKeep the dressings on for about a week. Showers are fine; avoid baths, swimming and hot tubs.[4]
First 2 weeksSome units ask you to keep a pain diary, so the team can see whether the treatment is working.[4]
Around 6 weeksOne NHS unit arranges a telephone follow-up at about 6 weeks.[4]
3 months onwardsThe main trials measured their results at 3 months.[7][10] Benefit, if it comes, often lasts years.[9][14]
  • Activity: build up walking and normal activities gradually. NICE recommends staying active and considering a group exercise programme for low back pain.[2]
  • Work: return depends on your job and how you feel; ask your team.
  • Leg pain: a spell of pain down a leg can follow. In one trial these episodes settled in a median of 43 days.[11] Tell your team if it happens.

Risks

Serious complications are uncommon. In the trials, there were no serious events judged to be caused by the device through 5 years of follow-up.[14] Your own risk depends on your health.

  • Leg pain (radicular pain): from about 2 in 100 in a review of 1,145 patients[19] to about 10 in 100 procedures in a trial, where most cases were linked to the needle breaking through the wall of the pedicle. Almost all settled.[11][19]
  • Any complication: about 3 in 100 in the review of 1,145 patients, or about 1 in 100 if short-lived leg pain is not counted.[19]
  • Fracture of a treated vertebra: about 1.6 in 100 overall in a US records study of 2,387 patients. The rate was about 4.6 in 100 in people with thin bones (osteoporosis or osteopenia), against about 0.4 in 100 in others.[20] Fracture was also the most often reported problem in the US device safety database, although that cannot show how common it is.[21]
  • Bleeding: bleeding or infection along the needle track is rare.[4] Bleeding behind the abdomen (a retroperitoneal bleed) was reported once in the sham-controlled trial,[16] and appears in device safety reports.[21]
  • Other: soreness at the cut, temporary difficulty passing urine, and wound infection were each reported in about 1 in 127 procedures in one trial.[11] Sedation or anaesthesia carries its own small risks: two deaths in US device safety reports were linked to anaesthesia, not to the device or procedure.[21]
  • X-rays: the procedure uses X-rays; tell the team if you are or may be pregnant.[4]
  • No benefit: some people get little or no relief; see the figures above.[16][17]

When to get help afterwards

For emergencies, see the red box above. Ask for an urgent GP appointment or contact NHS 111 if you have back pain and feel hot, cold, shivery or generally unwell, or if your pain is severe, starts suddenly or is getting worse quickly.[1] Contact your treating team about new or worsening leg pain, a red or weeping wound, or a sudden increase in back pain after a fall or minor strain.

Alternatives

  • Staying active and exercise: NICE suggests considering a group exercise programme, and manual therapy only alongside exercise.[2] See our physiotherapy guide.
  • Painkillers: discuss with your GP or pharmacist.[2]
  • Antibiotics for Modic changes: a Norwegian trial of 180 people found that 3 months of antibiotics gave no clinically important benefit over a dummy tablet, and caused more side effects.[22]
  • Radiofrequency denervation of the facet joints: for pain thought to come from the facet joints, after a positive test block.[2]
  • Surgery: spinal fusion for low back pain is considered only in rare circumstances and/or as part of a research study; NICE advises it should not be offered for low back pain except in a randomised controlled trial, and that disc replacement should not be offered.[2] See our lumbar fusion guide.

Questions to ask

  • Do you think my pain comes from the endplates, and why?
  • Which levels show Modic changes, and which would be treated?
  • Is my bone strength a concern, and should it be checked first?
  • Will I have sedation or local anaesthetic only?
  • What results and complication rates does your unit see?
  • What else could I try first, and what happens if it does not help?

Frequently asked questions

Is basivertebral nerve ablation available on the NHS?

It is offered in a small number of NHS hospitals.[4] NICE has not yet issued guidance on it and is assessing the procedure now, with no publication date set.[3] Until then, availability depends on local decisions. Your GP or spinal specialist can tell you what is offered in your area.

Does basivertebral nerve ablation hurt?

It is done with local anaesthetic, and many units also give sedation, so you are awake but drowsy.[4][11] One NHS leaflet says the heating usually hurts only for the first few seconds, and pain relief is given.[4] Afterwards some people have soreness at the small cut, and a spell of leg pain affects about 2 in 100[19] to 10 in 100.[11]

How long does it take to work, and how long does it last?

The main trials judged their results at 3 months.[7][10] For people who are helped, benefit often lasts years: in follow-up of the treated groups, about a third were pain free after an average of 5.6 to 6.4 years.[9][14] Not everyone benefits. In routine practice, about half of people reported their pain at least halved after a year.[17]

Can basivertebral nerve ablation be repeated?

There is very little evidence about repeating it. In pooled long-term follow-up, about 13 in 100 people needed another injection, ablation or operation for the same pain at the same level by 5 years.[14] If your pain returns, ask your team what they would advise.

I have osteoporosis. Can I have basivertebral nerve ablation?

It needs careful thought. In a US records study, a fracture of a treated vertebra followed in about 4.6 in 100 people with thin bones, compared with about 0.4 in 100 in others.[20] The main trials excluded people with fragile bones or a previous fragility fracture.[11] Tell your team about any bone thinning or fracture before treatment.

Is basivertebral nerve ablation the same as radiofrequency treatment for facet joints?

No. Both use radiofrequency heat, but they treat different nerves. Facet joint treatment targets the medial branch nerves at the back of the spine, and NICE suggests considering it after a positive test block.[2] BVNA targets a nerve inside the vertebra, for pain thought to come from the endplates, and NICE has not yet published guidance on it.[3]

When should I get urgent help after the procedure?

Go to A&E or call 999 straight away if you have back pain with pain, tingling, weakness or numbness in both legs, numbness around your genitals or bottom, or changes in bladder, bowel or sexual function. Ask for an urgent GP appointment or contact NHS 111 if you feel hot, cold, shivery or generally unwell.[1] Contact your treating team about new leg pain or a red or weeping wound.

Further reading

References

  1. NHS. Back pain. NHS website; page last reviewed 5 March 2026. Link
  2. National Institute for Health and Care Excellence. Low back pain and sciatica in over 16s: assessment and management (NG59). Published 30 November 2016; last updated 29 July 2026. Link
  3. National Institute for Health and Care Excellence. Radiofrequency ablation of the basivertebral nerve for chronic low back pain. Guidance in development, GID-HTG10871; expected publication date to be confirmed. Page accessed 18 October 2026. Link
  4. Oxford University Hospitals NHS Foundation Trust, Nuffield Orthopaedic Centre. Basivertebral nerve ablation: information for patients (OMI 101147). November 2024; review November 2027. Link
  5. Modic MT, Steinberg PM, Ross JS, Masaryk TJ, Carter JR. Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology. 1988;166(1 Pt 1):193-199. Link
  6. Jensen TS, Karppinen J, Sorensen JS, Niinimäki J, Leboeuf-Yde C. Vertebral endplate signal changes (Modic change): a systematic literature review of prevalence and association with non-specific low back pain. Eur Spine J. 2008;17(11):1407-1422. Link
  7. Fischgrund JS, Rhyne A, Franke J, et al. Intraosseous basivertebral nerve ablation for the treatment of chronic low back pain: a prospective randomized double-blind sham-controlled multi-center study. Eur Spine J. 2018;27(5):1146-1156. Link
  8. Fischgrund JS, Rhyne A, Franke J, et al. Intraosseous basivertebral nerve ablation for the treatment of chronic low back pain: 2-year results from a prospective randomized double-blind sham-controlled multicenter study. Int J Spine Surg. 2019;13(2):110-119. Link
  9. Fischgrund JS, Rhyne A, Macadaeg K, et al. Long-term outcomes following intraosseous basivertebral nerve ablation for the treatment of chronic low back pain: 5-year treatment arm results from a prospective randomized double-blind sham-controlled multi-center study. Eur Spine J. 2020;29(8):1925-1934. Link
  10. Khalil JG, Smuck M, Koreckij T, et al. A prospective, randomized, multicenter study of intraosseous basivertebral nerve ablation for the treatment of chronic low back pain. Spine J. 2019;19(10):1620-1632. Link
  11. Smuck M, Khalil J, Barrette K, et al. Prospective, randomized, multicenter study of intraosseous basivertebral nerve ablation for the treatment of chronic low back pain: 12-month results. Reg Anesth Pain Med. 2021;46(8):683-693. Link
  12. Koreckij T, Kreiner S, Khalil JG, et al. Prospective, randomized, multicenter study of intraosseous basivertebral nerve ablation for the treatment of chronic low back pain: 24-month treatment arm results. N Am Spine Soc J. 2021;8:100089. Link
  13. Smuck M, Truumees E, Macadaeg K, Jaini AM, Chatterjee S, Levin J. Intraosseous basivertebral nerve ablation: pooled long-term outcomes from two prospective clinical trials. Interv Pain Med. 2023;2(2):100256. Link
  14. Khalil JG, Truumees E, Macadaeg K, et al. Intraosseous basivertebral nerve ablation: a 5-year pooled analysis from three prospective clinical trials. Interv Pain Med. 2024;3(4):100529. Link
  15. Conger A, Schuster NM, Cheng DS, et al. The effectiveness of intraosseous basivertebral nerve radiofrequency neurotomy for the treatment of chronic low back pain in patients with Modic changes: a systematic review. Pain Med. 2021;22(5):1039-1054. Link
  16. Conger A, Burnham TR, Clark T, Teramoto M, McCormick ZL. The effectiveness of intraosseous basivertebral nerve radiofrequency ablation for the treatment of vertebrogenic low back pain: an updated systematic review with single-arm meta-analysis. Pain Med. 2022;23(Suppl 2):S50-S62. Link
  17. McCormick ZL, Fogarty AE, Conger A, et al. The effectiveness of basivertebral nerve radiofrequency ablation for the treatment of vertebrogenic low back pain: 1-year results of a prospective real-world cohort study. Pain Med. 2026;27(3):254-261. Link
  18. Sherwood D, Miller S, Epps A, et al. A first estimate of the annual prevalence of basivertebral nerve ablation candidates in a spine clinic. Pain Med. 2022;23(11):1858-1862. Link
  19. Hoelzer BC, Obray A, Naidu R, et al. Analysis of complications associated with basivertebral nerve ablation for vertebrogenic low back pain: a multicenter retrospective cohort study of 1,145 patients. Pain Med. 2026. doi:10.1093/pm/pnag122. PMID: 42765343. Link
  20. Chau J, Ghosh D, Fox S, Takashima AD, Stephens A. Rates of lumbar vertebral body compression fracture after basivertebral nerve ablation: a retrospective study utilizing a large national database. Interv Pain Med. 2025;4(4):100654. Link
  21. Fischer A, Cooper AN, McGuire F, et al. Adverse events associated with basivertebral nerve radiofrequency ablation: a comprehensive analysis from the MAUDE database. Interv Pain Med. 2026;5(3):100801. Link
  22. Bråten LCH, Rolfsen MP, Espeland A, et al. Efficacy of antibiotic treatment in patients with chronic low back pain and Modic changes (the AIM study): double blind, randomised, placebo controlled, multicentre trial. BMJ. 2019;367:l5654. Link
  23. Sayed D, Naidu RK, Patel KV, et al. Best practice guidelines on the diagnosis and treatment of vertebrogenic pain with basivertebral nerve ablation from the American Society of Pain and Neuroscience. J Pain Res. 2022;15:2801-2819. Link

This article is general information and is not a substitute for advice about your own situation. Please speak to your GP or specialist before making any change to your treatment.

Last checked: October 2026