Jeffrey S Fischgrund1, A Rhyne2, J Franke3, R Sasso4, S Kitchel5, H Bae6, C Yeung7, E Truumees8, M Schaufele9, P Yuan10, P Vajkoczy11, M DePalma12, D G Anderson13, L Thibodeau14, B Meyer15. 1. Department of Orthopedic Surgery, Oakland University William Beaumont School of Medicine, 3535 West 13 Mile Road, Suite 744, Royal Oak, MI, 48073, USA. jsfischgrund37@gmail.com. 2. Ortho Carolina Spine Center, Charlotte, USA. 3. Department of Orthopedics-Spine and Pediatric Orthopedics, Klinikum Magdeburg GmbH, Magdeburg, Germany. 4. Department of Orthopedic Surgery, Indiana University School of Medicine, Indianapolis, USA. 5. NeuroSpine Institute, Eugene, USA. 6. Department of Surgery, Cedars Sinai Medical Center, Los Angeles, USA. 7. Desert Institute for Spine Care, Phoenix, USA. 8. Seton Spine and Scoliosis Center, Seton Medical Center, Brackenridge University Hospital, Austin, USA. 9. Pain Solutions Treatment Centers, Marietta, USA. 10. Long Beach Memorial Medical Center, Long Beach, USA. 11. Department of Neurosurgery, Charité-Universitaetsmedizin Berlin, Campus Virchow Medical Center, Berlin, Germany. 12. Virginia iSpine Physicians, Richmond, USA. 13. Departments of Orthopaedic and Neurological Surgery, Thomas Jefferson University, Philadelphia, USA. 14. Maine Spine Surgery, Portland, USA. 15. Direktor der Neurochirurgischen Klinik und Poliklinik, Klinikum Rechts der Isar, Munich, Germany.
Abstract
PURPOSE: To evaluate the safety and efficacy of radiofrequency (RF) ablation of the basivertebral nerve (BVN) for the treatment of chronic low back pain (CLBP) in a Food and Drug Administration approved Investigational Device Exemption trial. The BVN has been shown to innervate endplate nociceptors which are thought to be a source of CLBP. METHODS: A total of 225 patients diagnosed with CLBP were randomized to either a sham (78 patients) or treatment (147 patients) intervention. The mean age within the study was 47 years (range 25-69) and the mean baseline ODI was 42. All patients had Type I or Type II Modic changes of the treated vertebral bodies. Patients were evaluated preoperatively, and at 2 weeks, 6 weeks and 3, 6 and 12 months postoperatively. The primary endpoint was the comparative change in ODI from baseline to 3 months. RESULTS: At 3 months, the average ODI in the treatment arm decreased 20.5 points, as compared to a 15.2 point decrease in the sham arm (p = 0.019, per-protocol population). A responder analysis based on ODI decrease ≥ 10 points showed that 75.6% of patients in the treatment arm as compared to 55.3% in the sham control arm exhibited a clinically meaningful improvement at 3 months. CONCLUSION: Patients treated with RF ablation of the BVN for CLBP exhibited significantly greater improvement in ODI at 3 months and a higher responder rate than sham treated controls. BVN ablation represents a potential minimally invasive treatment for the relief of chronic low back pain. These slides can be retrieved under Electronic Supplementary Material.
RCT Entities:
PURPOSE: To evaluate the safety and efficacy of radiofrequency (RF) ablation of the basivertebral nerve (BVN) for the treatment of chronic low back pain (CLBP) in a Food and Drug Administration approved Investigational Device Exemption trial. The BVN has been shown to innervate endplate nociceptors which are thought to be a source of CLBP. METHODS: A total of 225 patients diagnosed with CLBP were randomized to either a sham (78 patients) or treatment (147 patients) intervention. The mean age within the study was 47 years (range 25-69) and the mean baseline ODI was 42. All patients had Type I or Type II Modic changes of the treated vertebral bodies. Patients were evaluated preoperatively, and at 2 weeks, 6 weeks and 3, 6 and 12 months postoperatively. The primary endpoint was the comparative change in ODI from baseline to 3 months. RESULTS: At 3 months, the average ODI in the treatment arm decreased 20.5 points, as compared to a 15.2 point decrease in the sham arm (p = 0.019, per-protocol population). A responder analysis based on ODI decrease ≥ 10 points showed that 75.6% of patients in the treatment arm as compared to 55.3% in the sham control arm exhibited a clinically meaningful improvement at 3 months. CONCLUSION:Patients treated with RF ablation of the BVN for CLBP exhibited significantly greater improvement in ODI at 3 months and a higher responder rate than sham treated controls. BVN ablation represents a potential minimally invasive treatment for the relief of chronic low back pain. These slides can be retrieved under Electronic Supplementary Material.
Entities:
Keywords:
Basivertebral nerve; Chronic low back pain; Degenerative disc disease; IDE trial; Radiofrequency ablation; Randomized controlled study; Sham controlled
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