OBJECTIVE: Determine the effectiveness of intraosseous basivertebral nerve radiofrequency neurotomy for the treatment of chronic low back pain with type 1 or 2 Modic changes.
DESIGN: Systematic review.
POPULATION: Persons aged >18 years with chronic low back pain with type 1 or 2 Modic changes.
INTERVENTION: Intraosseous basivertebral nerve radiofrequency neurotomy.
COMPARISON: Sham, placebo procedure, active standard care treatment, or none.
OUTCOMES: The primary outcome of interest was the proportion of individuals with =50% pain reduction. Secondary outcomes included =10-point improvement in function as measured by Oswestry Disability Index as well as =2-point reduction in pain score on the Visual Analog Scale or Numeric Rating Scale, and decreased use of pain medication.
METHODS: Three reviewers independently assessed publications before 5/15/2020 in MEDLINE and Embase and the quality of evidence was evaluated using the Grades of Recommendation, Assessment, Development, and Evaluation framework.
RESULTS: Of the 725 publications screened, seven publications with 321 participants were ultimately included. The reported three-month success rate for =50% pain reduction ranged from 45-63%. Rates of functional improvement (=10-point Oswestry Disability Index improvement threshold) ranged from 75-93%. For comparison to sham treatment, the relative risk of treatment success defined by =50% pain reduction and =10-point Oswestry Disability Index improvement was 1.25 (95% Confidence Interval: 0.88 - 1.77) and 1.38 (95% Confidence Interval: 1.10 - 1.73), respectively. For comparison to continued standard care treatment the relative risk of treatment success defined by =50% pain reduction and =10-point Oswestry Disability Index improvement was 4.16 (95% Confidence Interval: 2.12 - 8.14) and 2.32 (95% Confidence Interval: 1.52 - 3.55), respectively.
CONCLUSION: There is moderate-quality evidence that suggests this procedure is effective in reducing pain and disability in patients with chronic low back pain who are selected based on type 1 or 2 Modic changes, among other inclusion and exclusion criteria used in the published literature to date. Success of the procedure appears to be dependent on effective targeting of the BVN. Non-industry funded high-quality, large prospective studies are needed to confirm these findings.
BVN radiofrequency ablation represents a possible minimally invasive treatment for the relief of chronic low back pain. It appears to be a good treatment option, but is not yet a panacea for this clinical condition that is so prevalent among individuals.
This is a high quality SR for Basivertebral nerve RFN for patients reporting CLBP of at least 6 months duration who have failed to respond to 6 months of nonsurgical management and who have evidence of Modic type 1 and 2 changes in vertebral endplates between L3 and S1. Although there is moderate-quality evidence that BVN RFN is an effective treatment for reducing pain and disability in appropriately selected patients, the differences between BVN RFN and sham were small.
Another potential treatment target for CLBP. Identifying the best subjects for this treatment remains problematic. Prevention (abdominal adiposity avoidance) is still likely to be best overall.