Early pain-response trajectories after basivertebral nerve ablation and their relationship to 12-month clinical outcomes

Background Basivertebral nerve ablation (BVNA) is an established treatment for vertebrogenic low back pain, but the relationship between early post-procedural response and longer-term outcomes remains unclear. Objective To evaluate whether early pain-response trajectories following BVNA were associated with 12-month clinical outcomes and to identify a clinically useful time point for reassessment. Methods This prospective multicenter observational cohort study included 140 patients with MRI-confirmed Modic type 1 or 2 changes treated with BVNA between April 2024 and April 2025. Patients reported weekly percent pain relief through 8 weeks, followed by assessments at 3, 6, and 12 months. The primary outcome was ≥50% pain relief at 12 months. Discriminative performance of Week 3 and Week 6 responses was assessed using sensitivity, specificity, likelihood ratios, and receiver operating characteristic analysis. Time to first ≥50% relief was evaluated using Kaplan–Meier methods. Secondary outcomes included changes in Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), Patient Global Impression of Change (PGIC), and post-procedural healthcare utilization. Results At 12 months, 82.1% achieved ≥50% pain relief. The mean NRS improved by 4.3 points and the mean ODI improved by 34 points, with 84.3% and 94.3% achieving Minimally Clinically Important Difference (MCID) thresholds, respectively. The Week 3 response was linked to increased likelihood of 12-month success (LR + 2.13; LR − 0.25). Discrimination of long-term outcomes was greater at Week 6 when analyzed continuously (AUC 0.96), with an optimal threshold of approximately 38% pain relief. All patients who achieved ≥30% pain relief by Week 6 also achieved clinically meaningful improvement at 12 months, whereas only 50% of those without early improvement achieved this threshold . Most 12-month responders achieved ≥50% relief within 4–6 weeks. Early improvement also corresponded to greater functional recovery and reduced subsequent spine-related interventions. Conclusion Early pain-response trajectories following BVNA were associated with 12-month outcomes. Clinically meaningful submaximal improvement (≥30%) identified patients who attained durable benefit, whereas absence of early improvement was linked to a lower likelihood of long-term success. These findings suggest that meaningful response signals may emerge before conventional ≥50% responder thresholds are reached, providing a more nuanced framework for interpreting early post-procedural response.