Intraosseous Basivertebral Nerve Ablation in the Treatment of Vertebrogenic Back Pain Secondary to Advanced Osteopenia: A Case Report

Low back pain in advanced osteopenia and osteoporosis continues to challenge the pain provider in offering effective analgesia for this growing population. Basivertebral nerve ablation is proven to benefit vertebrogenic back pain. A relative contraindication to basivertebral nerve ablation is metabolic bone disease. An 81-year-old male with a medical history of advanced osteopenia, with a T-score of -2.2, presented to an outpatient pain clinic with chronic low back pain. MRI of the spine demonstrated Type 1 and Type 2 Modic changes of the L3, L4, and L5 vertebral endplates, without evidence of fracture. The patient underwent an intraosseous basivertebral nerve ablation of the L3, L4, and L5 vertebrae, and follow-up appointments up to six months demonstrated a reduction in the patient's Numeric Pain Rating Scale by 6 and an improvement in quality of life. We successfully performed intraosseous basivertebral nerve ablations in a patient with advanced osteopenia, for the treatment of vertebrogenic back pain.