Article Figures & Data
Figures
- Figure 1
Anteroposterior (A) and lateral (B) conventional radiographs of the lumbar spine taken in a 73-year-old patient with a 15° lumbar scoliosis (A; white lines Cobb angle measurement) and L4–L5 lateral spondylolisthesis (white arrow). (B) Loss of lumbar lordosis (white line). After basivertebral nerve ablation L1–S1 with previous laminectomy. The patient had good improvement of Oswestry Disability Index (60 points) to 24 points (moderate disability of daily activities) and VAS (6 cm) to 2 cm at the last follow-up.
- Figure 2
(A) Lateral x-ray retrolisthesis with disc narrowing seen at L5–S1 in 42-year-old nurse. (B) Sagittal T2-weighted, short TI inversion recovery, and T1 weighted magnetic resonance images show Modic 1 changes of L5 and S1 with modrate-severe disc degeneration. This spondylolisthesis without pars defect responded well to basivertebral nerve ablation. The preoperative visual analog scale score of 8 cm improved to 1 cm and Oswestry Disability Index improved from 52 to 10 points.
- Figure 3
Sagittal T2-weighted (A), short TI inversion recovery (B), and sagittal T1 weighted (C) magnetic resonance images of a patient with old injury from parachuting. Panels A, B, and C show Modic 1 and Modic 2 changes around Schmorl’s nodes at L1–L4 (white arrows at each VEP disruption). After basivertebral nerve ablation L1–L5, the visual analog scale improved 8 cm to 0 and the Oswestry Disability Index improved 40 points from 52 to 10 at the last follow-up.
- Figure 4
Anteroposterior (A) and lateral (B) conventional radiographs of the lumbar spine taken in a 79-year-old patient (A) with a 15° lumbar scoliosis (white lines Cobb angle measurement). (B) Sagittal imbalance with loss of lumbar lordosis (white curved line; pelvic tilt [PT] = 37, pelvic incidence [PI] = 54.4, PI–L1 = 30.7). (C) sagittal T1 and (D) T2-weighted magnetic resonance images of same patient show Modic 1 and Modic 2 changes around Schmorl’s nodes vertebral endplate (VEP) damage at L1–L4 (white arrows at each VEP disruption in panels C and D). (E) T2-weighted axial image shows severe central and foraminal stenosis. This patient refused corrective subtraction osteotomy or laminectomy. After basivertebral nerve ablation (BVNA) L2–S1, VAS improved 9 cm (from 10 to 1) and Oswestry Disability Index improved 58 points (from 70 to 12) at the last follow-up. The patient was very satisfied with the BVNA result and said he would not do an osteotomy.
Tables
Demographics Group A (n = 41) Group B (n = 77) Women, n (%) 18 44 Men, n (%) 23 33 Age, y, mean (range) 68 (40–90) 71 (43–88) Working before BVNA 12 18 CLBP ≥2 y 41 (100%) 74 (96%) Opioid use, preoperative 9 (22%) 9 (11%) VAS score, preoperative, mean (range) 9 (5–10) 9 (7–10) ODI score, preoperative, mean (range) 53 (32–78) 58 (19–80) Abbreviations: BVNA, basivertebral nerve ablation; CLBP, chronic low back pain; ODI, Oswestry Disability Index; VAS, visual analog scale.
Adult Spinal Deformity Group A, n (%) Group B, n (%) Scoliosis 33 (80) 54 (70) Severe scoliosis (>20°) 2 (5) 4 (5) Loss of sagittal balance 3 (7) 9 (12) Spondylolisthesis 39 (95) 54 (70) Spondylolisthesis + mobility 0 22 (29) Stenosis 12 (29) 33 (43) Previous laminectomy 7 (17) 17 (22) Previous fusion 0 10 (13) Previous vertebroplasty 1 (2) 1 (1) After BVNA Group A Group B Total No. of BVNA levels 167 336 L2 level included, n 17 40 Opioid use at LFU, n (%) 5 (12%) 15 (20%) Fusion recommended after BVNA, n (%) 0 17 (22%) VAS score at LFU, mean (range) 2 (0–5) 3 (0–10) ODI score at LFU, mean (range) 14 (0–52) 29 (0–78) Interval to LFU, d, mean (range) 261 (11–844) 300 (6–783) Abbreviations: BVNA, basivertebral nerve ablation; LFU, last follow-up; ODI, Oswestry Disability Index; VAS, visual analog scale.
Complications Group A Group B Posterior column pain (radiculopathy, facet, sacroiliac joint, and hip) 5 (12) 21 (27) Nonspecific CLBP 1 (2) 15 (19) Stenosis radiculopathy peripheral neuropathy 2 (5) 22 (28) SI joint pain 0 8 (10) SI fusion performed 0 2 (3) VCF fragility fracture 0 9 (13) Fusion recommended 0 17 (22) Fusion performed 0 1 (1) Revision BVNA 1 (2) 1 (1) Failed revision BVNA 0 1 (1) Abbreviations: BVNA, basivertebral nerve ablation; CLBP, chronic low back pain; VCF, vertebral compression fracture.
Subgroups in Group B n VAS Score, Preoperative VAS Score, LFU ODI Score, Preoperative ODI Score, Postoperative LFU, d Adjacent to previous fusion 12 9 2 41 25 309 Sagittal imbalance 9 9 3 62 19 125 Laminectomy 26 9 2 52 21 283 Fusion recommended after BVNA 22 9 4 64 37 300 Removal pedicle screws 5 9 3 57 29 183 Mobile spondylolisthesis 21 9 3 55 28 264 Osteoporotic fracture VCF 8 10 4 65 47 370 Abbreviations: BVNA , basivertebral nerve ablation; LFU, last follow-up; ODI, Oswestry Disability Index; VAS, visual analog scale; VCF, vertebral compression fracture.
Note: VAS, ODI, and LFU data are presented as means. VAS was measured on a 10-cm scale. ODI was measured on a 100-point scale.
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