Intracept® Procedure for Low Back Pain
Chronic low back pain can have many possible causes. For some patients, pain may arise from damaged vertebral endplates—the areas where the spinal bones and discs meet. When a patient’s symptoms, examination, and MRI findings support the vertebral endplates as the likely pain source, the condition may be diagnosed as vertebrogenic low back pain.
The Intracept® Procedure is a minimally invasive treatment designed for appropriately selected patients with vertebrogenic pain. It targets the basivertebral nerve, which carries pain signals from the vertebral endplates.
Intracept® is not appropriate for every person with back pain. Determining candidacy requires a detailed medical history, physical examination, and careful review of imaging. At DFW Sports Medicine, patients in McKinney and Frisco, Texas, can receive a comprehensive evaluation to identify the likely source of their symptoms and discuss suitable treatment options.
What Is Vertebrogenic Low Back Pain?
The spine consists of individual bones called vertebrae, with cushioning discs between them. Each vertebra has an upper and lower endplate next to the disc.
Age-related degeneration and other changes involving a spinal disc and the adjacent vertebral endplates may activate pain signals carried by the basivertebral nerve. This nerve is located within the vertebral body and may transmit pain signals from the affected endplates.
Vertebrogenic pain is usually felt near the center of the lower back. Patients may describe it as a deep, aching, or burning pain. It may become worse with:
- Prolonged sitting
- Bending forward
- Lifting
- Physical activity
- Moving from sitting to standing
Symptoms vary, and these features alone do not confirm vertebrogenic pain. Disc-related pain, facet joint arthritis, sacroiliac joint dysfunction, spinal stenosis, nerve compression, and other conditions can cause similar symptoms.
If the symptoms or imaging point to another condition, the physician will discuss the treatment approach that best fits the diagnosis. This may include care described on the Spine Pain and Injury page.
How Does the Basivertebral Nerve Contribute to Pain?
The basivertebral nerve runs through the vertebral body and carries sensory information from the vertebral endplates. When an endplate becomes damaged or inflamed, this nerve may transmit the deep, aching pain associated with vertebrogenic low back pain.
The Intracept® Procedure is designed to target this nerve directly. This differs from treatments that address pain arising from the facet joints, sacroiliac joints, spinal nerves, discs, or surrounding muscles and soft tissues.
What Are Modic Changes?
An MRI can identify changes in the vertebral endplates and nearby bone marrow. These findings are called Modic changes.
The two types most commonly associated with vertebrogenic pain are:
- Modic Type 1 changes: These may indicate inflammation and fluid within the bone marrow near an endplate.
- Modic Type 2 changes: These reflect fatty changes in the bone marrow next to an endplate.
The presence of Modic Type 1 or Type 2 changes can support a diagnosis of vertebrogenic pain when the MRI findings correspond with the patient’s symptoms and physical examination.
Modic changes do not automatically mean that a patient needs a procedure. Some people have these MRI findings without experiencing significant pain. Imaging must therefore be considered together with the patient’s symptoms, examination findings, medical history, and response to previous treatment.
How Does the Intracept® Procedure Work?
The Intracept® Procedure is also known as basivertebral nerve ablation. It uses radiofrequency energy to interrupt pain signals traveling through the basivertebral nerve.
During the procedure, the physician uses imaging guidance to access the affected vertebral body through a small incision. A specialized probe is positioned near the basivertebral nerve. Controlled radiofrequency energy is then applied to ablate the targeted portion of the nerve.
Intracept® does not fuse the spine or leave a permanent implant. It is generally performed as an outpatient procedure. The treatment setting, anesthesia plan, and recovery instructions depend on the patient’s health, anatomy, and individual circumstances.
Who May Be a Candidate for Intracept®?
Intracept® is generally considered for skeletally mature patients with chronic vertebrogenic low back pain associated with Modic Type 1 or Type 2 changes from L3 through S1.
A patient may be considered for the Intracept® Procedure when several factors are present, including:
- Low back pain that has continued for at least six months
- Pain located primarily in the lower back rather than predominantly traveling down the leg
- Symptoms consistent with vertebral endplate pain
- Modic Type 1 or Type 2 changes involving one or more vertebral bodies from L3 through S1 on a lumbar MRI
- Persistent symptoms despite an appropriate course of nonsurgical care
- Pain that interferes with daily activities, work, sleep, exercise, or quality of life
Nonsurgical care may include physical therapy, a home exercise program, activity modification, anti-inflammatory or other medications when medically appropriate, and selected injections or other treatments.
These factors are general considerations and do not guarantee that a patient will qualify. Insurance plans may also have separate medical-necessity, documentation, and authorization requirements.
Who May Not Be an Appropriate Candidate?
A patient may not be an appropriate candidate when another condition appears to be the primary cause of the symptoms or when the risks of the procedure outweigh its potential benefits.
Conditions that may require a different treatment approach include:
- A compressed spinal nerve
- A herniated disc causing predominant leg pain
- Lumbar spinal stenosis with symptoms primarily triggered by standing or walking
- Facet joint pain
- Sacroiliac joint dysfunction
- Muscle or soft-tissue pain
- Spinal fracture
- Active infection
- Tumor involving the spine
- Another condition that better explains the symptoms
Pregnancy, skeletal immaturity, certain medical conditions, or anatomical considerations may also make the procedure unsuitable. These issues must be evaluated individually.
Patients whose symptoms are caused primarily by lumbar spinal stenosis may require a different treatment. DFW Sports Medicine also offers the MILD® Procedure for certain appropriately selected patients with lumbar spinal stenosis.
How Does DFW Sports Medicine Evaluate Vertebrogenic Pain?
There is no single symptom or MRI finding that proves the basivertebral nerve is causing a person’s pain. A comprehensive evaluation typically includes the following:
Medical History
The physician will ask where the pain is located, what makes it better or worse, how long it has been present, and which treatments have already been attempted.
Physical Examination
The examination may assess spinal movement, strength, sensation, reflexes, and potential sources of pain outside the vertebral endplates.
MRI Review
The physician reviews the lumbar MRI for Modic changes and other abnormalities that could better explain the symptoms. An MRI report alone may not provide enough information, so direct review of the images can be important.
Clinical Correlation
The physician determines whether the symptoms, examination findings, and MRI findings fit together. A treatment decision should not be based solely on an imaging abnormality.
What Are the Potential Benefits of Intracept®?
For appropriately selected patients, potential benefits may include:
- Reduced vertebrogenic low back pain
- Improved ability to perform daily activities
- No permanent spinal implant
- Preservation of the spine’s existing structure
- Outpatient treatment through a relatively small incision
Individual outcomes vary, and meaningful pain relief or functional improvement cannot be guaranteed.
What Are the Potential Risks?
As with any minimally invasive spinal procedure, Intracept® has potential risks. These may include:
- Bleeding
- Infection
- Temporary soreness or worsening of pain
- Injury to nearby nerves or other structures
- Reaction to anesthesia or medications
- Failure to achieve meaningful pain relief
- The need for additional treatment
Additional risks may depend on the patient’s anatomy, medical conditions, and procedural level. Before treatment, the physician will review the potential benefits, risks, alternatives, and expected recovery.
What Should Patients Expect After the Intracept® Procedure?
Recovery varies among patients. Temporary soreness around the procedure area may occur. Patients receive individualized instructions regarding activity, medications, incision care, and follow-up.
Improvement may occur gradually rather than immediately. The amount and duration of relief can differ from one patient to another. Patients should discuss expected benefits, possible risks, alternatives, and recovery considerations with their physician before deciding whether to proceed.
Frequently Asked Questions
Is Intracept® the Same as Traditional Spine Radiofrequency Ablation?
No. Traditional lumbar radiofrequency ablation generally targets nerves that carry pain signals from the facet joints. Intracept® targets the basivertebral nerve inside the vertebral body and is intended for vertebrogenic pain associated with vertebral endplate changes.
Does Intracept® Treat Sciatica?
Intracept® does not directly treat a compressed spinal nerve or classic sciatica. If leg pain, numbness, tingling, or weakness is the main concern, the physician will evaluate for other causes and discuss treatments appropriate for the diagnosis.
Do Modic Changes Automatically Make Me a Candidate?
No. Modic Type 1 or Type 2 changes are an important part of the evaluation, but they must correspond with the patient’s symptoms and examination. Other possible causes of pain must also be considered.
Is Intracept® a Spinal Fusion?
No. The procedure does not fuse the vertebrae or involve the placement of rods, screws, or a permanent spinal implant.
How Long Does the Intracept® Procedure Take?
The length of the procedure depends on the number and location of the vertebral bodies being treated. The physician can provide more individualized information after reviewing the patient’s imaging and treatment plan.
Will Insurance Cover the Intracept® Procedure?
Coverage varies by insurance plan and the patient’s clinical circumstances. Prior authorization and documentation of previous conservative treatment may be required. Coverage and expected out-of-pocket costs should be confirmed before scheduling the procedure.
Schedule an Evaluation at DFW Sports Medicine
Persistent low back pain deserves an evaluation that considers more than an MRI report alone. If your symptoms have continued despite conservative treatment and your MRI shows Modic Type 1 or Type 2 changes, an evaluation can help determine whether vertebrogenic pain may be contributing to your symptoms.
Schedule an appointment at DFW Sports Medicine in McKinney or Frisco, Texas, to discuss your symptoms, medical history, imaging, and available treatment options. The physician will determine whether the Intracept® Procedure—or another treatment approach—is appropriate for you.