Abstract No. 271 The Straw That Won't Break the Camel's Back: Evaluating Earlier Integration of Basivertebral Nerve Ablation versus Adjunctive Interventions

Vertebrogenic pain, characterized by axial lower back pain worse with sitting and forward flexion and by Modic type I and II endplate changes on MRI, can be relieved by basivertebral nerve (BVN) radiofrequency ablation (RFA). BVN's multifaceted role in pain, such as via neurotization in degenerative disc disease and via nociception, suggests that standalone BVN RFA may alleviate chronic back pain. We aim to compare pain relief and functional outcomes as measured by the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) in patients who undergo BVN RFA with or without adjunctive medial branch nerve block (MBNB) and/or sacroiliac joint ablation (SIA). We conducted a single-center observational cohort study of all patients who underwent BVN RFA, with or without additional MBNB and/or SIA, from May 2022 to August 2023. We report baseline patient characteristics and evaluate whether pre- and post-intervention VAS pain and ODI scales differed among BVN RFA only group versus the combined treatment (BVN RFA + MBNB and/or SIA) group at follow-up. 17 patients (12 male, 5 female) underwent BVN RFA only, while 9 patients (2 male, 7 female) underwent combined treatment. Baseline characteristics including age (62.9 vs 55.8; p-value 0.16), BMI (29.3 vs 26.3; p-value 0.16), pain duration (13 vs 9 years; p-value 0.21), VAS (7.24 vs 8.17; p-value 0.06), and ODI (23.5 vs 26.3; p-value 0.12) were without significant difference between cohorts. 16 patients with available preliminary data were without significant differences between the cohorts in mean number of days to initial follow-up (66.8 vs 74.6; p-value 0.34) nor VAS score at that time (4.61 vs 4.64; p-value 0.49). While both groups saw significant mean VAS reduction from pre- to post-intervention (2.72, p-value 0.007 vs 3.5, p-value 0.01), VAS score reduction did not significantly vary between the cohorts (p-value 0.55). VAS scores at remaining initial and at 6-month follow-up will be similarly analyzed and reported. Patients who underwent BVN RFA with or without additional MBNB and/or SIA experienced significant pain reduction at initial follow-up without significant difference in VAS score reduction between the two groups. 6-month follow-up data will further characterize whether adjunctive intervention is non-superior to standalone BVN RFA. Future research with larger sample sizes and multi-center collaborations investigating potential advantages of earlier BVN RFA may optimize its placement in the treatment pathway for chronic back pain.