Chronic low back pain can have many possible causes. For some people, the pain begins in the vertebral endplates—the areas where the spinal bones and discs meet. This condition is known as vertebrogenic low back pain.
The Intracept® Procedure is a minimally invasive treatment designed specifically for appropriately selected patients with vertebrogenic pain. It targets the basivertebral nerve, which carries pain signals from damaged vertebral endplates.
However, Intracept is not appropriate for every person with back pain. Determining whether someone is a candidate 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.
Over time, degeneration, repeated stress, or injury may damage these endplates. The basivertebral nerve, located within the vertebral body, can transmit pain signals from the affected area.
Vertebrogenic pain is usually felt in 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. Other conditions—including disc problems, arthritis of the facet joints, sacroiliac joint dysfunction, spinal stenosis, and nerve compression—can cause similar symptoms.
What Are Modic Changes?
An MRI is used to look for 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 match the patient’s symptoms and examination.
Modic changes do not automatically mean that a patient needs a procedure. Some people have changes on an MRI 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 called 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 heat and ablate the targeted portion of the nerve.
Intracept does not place a permanent implant in the spine. It is generally performed as an outpatient procedure, although the specific setting, anesthesia plan, and recovery instructions depend on the patient’s health and individual circumstances.
Who May Be a Candidate for Intracept?
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 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 treatment 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, not a guarantee of candidacy. Insurance plans may also have their own medical-necessity and authorization requirements.
Who May Not Be an Appropriate Candidate?
Intracept is intended to treat pain arising from the vertebral endplates. It is not designed to treat every cause of low back pain.
A patient may not be an appropriate candidate when the primary source of pain appears to be:
- A compressed spinal nerve
- A herniated disc causing predominant leg pain
- Lumbar spinal stenosis with symptoms mainly triggered by standing or walking
- Facet joint arthritis
- Sacroiliac joint dysfunction
- Muscle or soft-tissue pain
- A spinal fracture, tumor, or active infection
- Another condition that better explains the symptoms
Certain medical conditions, pregnancy, active infection, skeletal immaturity, or anatomical considerations may also make the procedure unsuitable. A physician must assess these issues individually.
Patients with lumbar spinal stenosis may require a different approach. DFW Sports Medicine also offers the MILD® Procedure for certain appropriately selected patients with lumbar spinal stenosis.
How Is Vertebrogenic Pain Diagnosed?
There is no single symptom that proves the basivertebral nerve is causing a person’s pain. Diagnosis typically includes:
Medical History
The physician will ask where the pain is located, what makes it worse, how long it has been present, and which treatments have already been attempted.
Physical Examination
The examination helps evaluate spinal movement, strength, sensation, reflexes, and possible sources of pain outside the vertebral endplates.
MRI Review
The physician reviews the lumbar MRI for Modic changes and other abnormalities that might better explain the symptoms. An MRI report alone may not provide enough information; direct review of the images can be important.
Clinical Correlation
The final step is determining whether the symptoms, examination, and MRI findings fit together. A treatment decision should not be based solely on an imaging finding.
What Should Patients Expect After the Procedure?
Recovery varies among patients. Some soreness around the procedure area may occur temporarily. Patients receive individualized instructions regarding activity, medications, wound care, and follow-up.
Improvement may occur gradually rather than immediately. The amount and duration of relief can differ, and no procedure can guarantee a particular outcome. 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 a traditional spine radiofrequency ablation?
No. Traditional lumbar radiofrequency ablation usually 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 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 treatments.
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 vertebrae or involve the placement of rods, screws, or a permanent spinal implant.
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 should be confirmed before scheduling the procedure.
Schedule an Evaluation at DFW Sports Medicine
Persistent low back pain deserves a diagnosis that considers more than the MRI report alone. If your symptoms have continued despite conservative treatment and your MRI shows Modic changes, an evaluation can help determine whether vertebrogenic pain may be contributing.
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.