Chronic low back pain can come from several different structures in the spine. In some patients, the source of pain may be the vertebral endplates—the areas where the spinal bones and discs meet. This condition is known as vertebrogenic low back pain.
The Intracept® Procedure, also known as basivertebral nerve ablation, is a minimally invasive treatment designed for appropriately selected patients with chronic vertebrogenic low back pain. It targets the basivertebral nerve, which carries pain signals from the vertebral endplates.
Patients who may be candidates typically have chronic low back pain lasting at least six months, have not experienced adequate improvement with nonsurgical treatment, and have Modic Type 1 or Type 2 changes on lumbar MRI that correspond with their symptoms.
However, finding Modic changes on an MRI does not automatically mean that Intracept is appropriate. Chronic back pain can have multiple causes, making a careful history, physical examination, and review of the actual MRI important when determining the likely pain generator.
At DFW Sports Medicine, patients in McKinney and Frisco, Texas, can receive a comprehensive evaluation for chronic low back pain to determine whether vertebrogenic pain—or another spinal condition—may be responsible for their symptoms.
What Is Vertebrogenic Low Back Pain?
The spine consists of individual bones called vertebrae with cushioning discs between them. Each vertebral body has an upper and lower endplate adjacent to the disc.
Degeneration, repetitive stress, or injury can affect these vertebral endplates. The basivertebral nerve travels within the vertebral body and can transmit pain signals originating from the damaged endplate region.
Vertebrogenic pain is generally felt primarily in the middle or lower back rather than predominantly traveling down the leg. Patients may describe the pain as deep, aching, or burning.
Symptoms may become worse with activities or positions such as:
- Prolonged sitting
- Bending forward
- Lifting
- Physical activity
- Moving from sitting to standing
These symptoms alone do not establish a diagnosis of vertebrogenic pain. Herniated discs, lumbar spinal stenosis, facet joint pain, sacroiliac joint dysfunction, nerve compression, and other musculoskeletal conditions can produce similar symptoms.
Learn more about spine pain and injuries.
What Are Modic Changes on an MRI?
An MRI of the lumbar spine can identify changes involving the vertebral endplates and adjacent bone marrow. These findings are called Modic changes.
Two types are particularly relevant when evaluating patients for vertebrogenic low back pain:
- Modic Type 1 changes: Typically associated with inflammatory and fluid-related changes in the bone marrow adjacent to the vertebral endplate.
- Modic Type 2 changes: Characterized by fatty changes within the bone marrow adjacent to the vertebral endplate.
For appropriately selected patients, Modic Type 1 or Type 2 changes involving the vertebral endplates can support a diagnosis of vertebrogenic low back pain when the MRI findings correspond with the patient’s symptoms and physical examination.
The Intracept Procedure is generally used to treat qualifying vertebral levels from L3 through S1.
Importantly, Modic changes do not automatically mean that the basivertebral nerve is causing a patient’s pain. These MRI findings must be interpreted in the context of the patient’s symptoms, examination, medical history, and other abnormalities seen on imaging.
How Does the Intracept Procedure Work?
The Intracept Procedure is a form of basivertebral nerve ablation.
During the procedure, the physician uses imaging guidance to access the affected vertebral body through a small incision. A specialized probe is advanced within the vertebral body toward the location of the basivertebral nerve.
Controlled radiofrequency energy is then used to ablate the targeted basivertebral nerve and interrupt transmission of pain signals originating from the vertebral endplates.
Unlike spinal fusion, Intracept does not fuse vertebrae together and does not require placement of rods, screws, or a permanent spinal implant.
The procedure is generally performed in an outpatient setting. The specific procedure setting, anesthesia plan, and postoperative instructions depend on the patient’s individual circumstances.
Who May Be a Candidate for the Intracept Procedure?
Intracept is intended for carefully selected patients whose clinical symptoms and MRI findings are consistent with vertebrogenic low back pain.
Factors commonly considered during an evaluation include:
- Chronic low back pain that has persisted for at least six months
- Pain that is primarily located in the lower back rather than predominantly radiating down the leg
- Symptoms consistent with vertebral endplate-related pain
- Modic Type 1 or Type 2 changes identified on lumbar MRI
- Qualifying findings involving vertebral levels generally between L3 and S1
- Persistent symptoms despite an appropriate course of nonsurgical treatment
- Pain that meaningfully interferes with work, exercise, sleep, daily activities, or quality of life
Previous nonsurgical treatment may include physical therapy, a physician-directed home exercise program, activity modification, medications when medically appropriate, injections, or other conservative treatments.
These criteria should not be viewed as a checklist that automatically qualifies someone for the procedure. The key question is whether the vertebral endplates and basivertebral nerve are likely to be the primary source of the patient’s chronic low back pain.
Insurance companies may also have their own medical-necessity criteria and prior-authorization requirements.
Who May Not Be an Appropriate Candidate?
Intracept specifically addresses pain originating from the vertebral endplates and basivertebral nerve. It does not treat every cause of chronic low back pain.
A patient may not be an appropriate candidate when another condition appears to be the primary pain generator, including:
- Lumbar nerve-root compression
- A herniated disc causing predominantly radicular leg pain
- Symptomatic lumbar spinal stenosis
- Facet-mediated pain
- Sacroiliac joint dysfunction
- Predominantly muscular or soft-tissue pain
- Spinal fracture
- Tumor
- Active infection
The presence of another spinal abnormality does not necessarily mean that vertebrogenic pain cannot also be present. Many patients have more than one abnormality on an MRI. The physician’s role is to determine which finding is most consistent with the patient’s symptoms.
Other medical conditions, pregnancy, skeletal immaturity, or certain anatomical considerations may also affect whether basivertebral nerve ablation is appropriate.
For example, patients whose symptoms are primarily caused by lumbar spinal stenosis may require a different treatment approach. DFW Sports Medicine also offers the MILD® Procedure for certain appropriately selected patients with lumbar spinal stenosis.
How Is Vertebrogenic Low Back Pain Diagnosed?
There is no single symptom or MRI finding that proves that the basivertebral nerve is responsible for a person’s chronic back pain.
Instead, diagnosis requires clinical correlation between several pieces of information.
Medical History
Your physician will ask where the pain is located, how long it has been present, whether it travels into the legs, what activities or positions make it better or worse, and how significantly it affects your daily life.
Previous injuries, medical conditions, medications, treatments, injections, and other interventions may also be reviewed.
Physical Examination
A physical examination helps assess spinal movement, strength, sensation, reflexes, and other potential pain generators.
The examination may also help identify findings suggesting lumbar radiculopathy, spinal stenosis, facet-mediated pain, hip pathology, sacroiliac joint dysfunction, or another musculoskeletal condition.
Lumbar MRI Review
Your lumbar MRI can be reviewed for Modic Type 1 and Type 2 changes, as well as disc abnormalities, spinal stenosis, nerve compression, facet arthritis, and other findings that could potentially explain your symptoms.
An MRI report by itself does not establish a diagnosis of vertebrogenic pain.
Reviewing the imaging together with the patient’s history and examination is important because many people have abnormalities on spinal imaging that are not necessarily responsible for their pain.
Clinical Correlation
Finally, the physician considers whether the patient’s symptoms, physical examination, medical history, previous treatment response, and MRI findings fit together.
If the overall evaluation is consistent with vertebrogenic low back pain, the physician can discuss whether basivertebral nerve ablation with the Intracept Procedure may be an appropriate treatment option.
Is There Clinical Evidence for Basivertebral Nerve Ablation?
Basivertebral nerve ablation has been evaluated in clinical studies involving appropriately selected patients with chronic vertebrogenic low back pain.
Research has included randomized clinical trials as well as longer-term follow-up evaluating outcomes after basivertebral nerve ablation. These studies have reported improvements in pain and functional outcomes among appropriately selected patients.
However, clinical studies describe outcomes across groups of patients and cannot predict how any individual patient will respond. Appropriate patient selection remains an important part of determining whether the procedure should be considered.
What Should Patients Expect After Intracept?
Recovery varies from person to person.
Some temporary soreness around the procedure site may occur. Your physician will provide individualized instructions regarding wound care, activity, medications, and follow-up.
Pain improvement does not necessarily occur immediately. Changes may develop gradually following the procedure, and the amount and timing of improvement can differ between patients.
No treatment can guarantee a specific result.
Before undergoing Intracept, patients should discuss the potential benefits, risks, alternatives, and expected recovery with their physician.
Frequently Asked Questions About Intracept
Is Intracept the same as traditional lumbar radiofrequency ablation?
No. Traditional lumbar radiofrequency ablation generally targets nerves associated with the facet joints.
Intracept targets the basivertebral nerve located within the vertebral body and is intended for appropriately selected patients with vertebrogenic low back pain.
Does Intracept treat sciatica?
Intracept does not directly treat a compressed spinal nerve or classic sciatica.
If pain traveling down the leg, numbness, tingling, or weakness is a major component of your symptoms, your physician will evaluate for lumbar nerve compression or other potential causes.
Do Modic changes automatically make me a candidate for Intracept?
No.
Modic Type 1 or Type 2 changes are an important part of the evaluation, but the findings must correspond with your symptoms and overall clinical presentation. Other potential causes of chronic low back pain also need to be considered.
What spinal levels can be treated with Intracept?
For appropriately selected patients, the Intracept Procedure is generally used to treat qualifying vertebral levels from L3 through S1.
Your MRI and clinical findings must be reviewed to determine whether a particular vertebral level is an appropriate treatment target.
Is Intracept a spinal fusion?
No.
Intracept does not fuse the vertebrae together and does not involve placement of rods, screws, or a permanent spinal implant.
Will insurance cover the Intracept Procedure?
Coverage varies depending on the insurance plan and individual circumstances.
Some insurers require prior authorization and documentation demonstrating that specific medical-necessity criteria have been satisfied. Patients should confirm their individual benefits and authorization requirements with their insurance carrier.
Schedule an Intracept Evaluation in McKinney or Frisco, TX
Persistent low back pain does not always come from the same structure. Identifying the likely pain generator is an important step before choosing an interventional treatment.
If you have experienced chronic low back pain for six months or longer, have continued symptoms despite nonsurgical treatment, and your lumbar MRI demonstrates Modic Type 1 or Type 2 changes, you may benefit from an evaluation for vertebrogenic low back pain.
At DFW Sports Medicine, patients in McKinney, Frisco, and surrounding North Texas communities can receive an evaluation that includes their symptoms, physical examination, medical history, previous treatments, and lumbar imaging.
Schedule an appointment at DFW Sports Medicine to discuss whether the Intracept Procedure—or another treatment approach—may be appropriate for your condition.
This article is intended for general educational purposes and is not a substitute for individualized medical advice. Treatment recommendations depend on an individual’s diagnosis, examination, medical history, and imaging findings. Individual results vary.