Ep. 47 Pain Procedures: Basivertebral Nerve Ablation
Episode Summary
Join Justine Feitelson and Dr. Dan Bates in this episode of 'It's Not In Your Head' as they dive into the specifics of basivertebral nerve ablation (BVNA). Dr. Bates shares his insights on this innovative procedure for treating discogenic pain, highlighting the science behind the technique, its application, benefits and risks, and what aspects of pain it is most effective for. Listen as a clinician for clinical pearls from Dan’s personal journey in mastering this challenging but rewarding treatment in his practice, and to better understand how the procedure works and what outcomes you can really expect as a patient.
Episode Overview:
Basal vertebral nerve ablation (BVNA) is a targeted procedure for a very specific kind of chronic low back pain: disc-related pain with sudden, sharp “stop you in your tracks” episodes that block people from doing rehab and daily activities.
What BVNA Is For
BVNA is used for discogenic low back pain, especially when there are two components: a constant deep ache and intermittent sharp bolts of pain that make people freeze or fear movement (kinesiophobia).
In Dan’s experience, it is outstanding for the intermittent sharp pain and less consistently effective for the deep ache, with roughly 20–30% of people becoming almost pain free overall.
The “right” patient typically has central low back pain plus MRI evidence of type 1 or type 2 Modic changes (inflammatory changes in the bone next to the disc), which signal abnormal loading and irritated bone.
How BVNA Works
In disc degeneration, the disc (a shock absorber) wears out and then the bone on either side also degenerates, and it is this bone that seems to generate the intermittent sharp pain.
The basal vertebral nerve supplies the vertebral bone; in BVNA, a probe is passed through the bony pedicle into the vertebral body and the nerve area is heated to stop the abnormal pain signals.
Unlike classic radiofrequency ablation on facet or sacroiliac joint nerves (which often grow back along their sheath after 9–18 months), the tiny proliferative nerves inside the bone have no sheath, so when they are “cooked” they usually do not regrow, giving longer-lasting relief.
Effectiveness and Expected Results
Clinical trial data cited in the episode show that about 60–80% of patients achieve at least 50% pain reduction, and around 20–30% become pain free.
Pain scores often fall from about 6/10 to the 2–3/10 range; Dan suggests this residual pain is typically the remaining deep ache rather than the sharp, disabling spikes.
Functional improvement is striking: Oswestry Disability Index scores drop by roughly 20–30 points, meaning people can move more, do more, and participate better in rehab even if some ache remains.
Procedure, Risks, and Safety
Technically, BVNA is a more demanding spine procedure: a large needle is advanced through the pedicle into the middle of the vertebral body, sometimes with hammering, and the lesion is held for several minutes at high temperature.
Standard risks include infection, bleeding, and bruising, with extra bruising risk because bone and bone marrow are entered, plus rare but serious issues like pedicle wall fracture, nerve root compression, or vertebral crush fracture (especially in osteoporosis).
Dan notes early research used 15‑minute burns at 80°C, which raised concern for nerve injury; he now uses about a 4‑minute lesion to balance effect size and safety, and describes one suspected transient nerve irritation treated successfully with additional interventions.
Role in Recovery and Rehab
BVNA’s key benefit is that the sharp, unpredictable pain often improves very quickly—sometimes the next day, typically within a week—creating a window to safely restart core training, graded strengthening, and functional rehab.
The procedure is a tool, not a cure-all: it works very well if the basal vertebral nerve pain is truly the main driver, but will not help if the primary problem is something else, like facet joint pain.
Justine and Dan emphasize matching a specific diagnosis (disc-related bone pain with Modic changes and sharp episodes) to this specific procedure and setting realistic expectations about what it can and cannot fix.