Magnetic Resonance Imaging Characteristics Associated with Treatment Success from Basivertebral Nerve Ablation: An Aggregated Cohort Study of Multicenter Prospective Clinical Trials Data

Zachary L McCormick; Aaron Conger; Matthew Smuck; Jeffrey C Lotz; Joshua A Hirsch; Colton Hickman; Katrina Harper; Taylor R Burnham

doi:10.1093/pm/pnac093

Magnetic Resonance Imaging Characteristics Associated with Treatment Success from Basivertebral Nerve Ablation: An Aggregated Cohort Study of Multicenter Prospective Clinical Trials Data

Pain Med. 2022 Jul 20;23(Suppl 2):S34-S49. doi: 10.1093/pm/pnac093.

Authors

Zachary L McCormick¹, Aaron Conger¹, Matthew Smuck², Jeffrey C Lotz³, Joshua A Hirsch⁴, Colton Hickman¹, Katrina Harper⁵, Taylor R Burnham¹

Affiliations

¹ Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, Utah, USA.
² Department of Orthopedics, Stanford University, Palo Alto, California, USA.
³ Department of Orthopedics, University of California San Francisco, San Francisco, California, USA.
⁴ Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁵ Technomics Research LLC, Mi nneapolis, Minnesota, USA.

Abstract

Objective: Investigate associations between endplate and motion segment magnetic resonance imaging (MRI) characteristics and treatment outcomes following basivertebral nerve radiofrequency ablation (BVN RFA) in patients with clinically suspected vertebral endplate pain (VEP).

Design: Aggregated cohort study of 296 participants treated with BVN RFA from three prospective clinical trials.

Methods: Baseline MRI characteristics were analyzed using stepwise logistic regression to identify factors associated with treatment success. Predictive models used three definitions of treatment success: (1) ≥50% low back pain (LBP) visual analog scale (VAS), (2) ≥15-point Oswestry Disability Index (ODI), and (3) ≥50% VAS or ≥15-point ODI improvements at 3-months post-BVN RFA.

Results: The presence of lumbar facet joint fluid (odds ratio [OR] 0.586) reduced the odds of BVN RFA treatment success in individuals with clinically suspected VEP. In patients with a less advanced degenerative disc disease (DDD) profile, a > 50% area of the endplate with bone marrow intensity changes (BMIC) was predictive of treatment success (OR 4.689). Both regressions areas under the curve (AUCs) were under 70%, indicating low predictive value. All other vertebral endplate, intervertebral disc, nerve roots facet joint, spinal segmental alignment, neuroforamina, lateral recesses, and central canal MRI characteristics were not associated with BVN RFA success.

Conclusions: In patients with vertebrogenic low back pain with Modic changes, the presence of degenerative findings of the anterior and posterior column was not associated with a clinically important impact on BVN RFA treatment success. None of the models demonstrated strong predictive value, indicating that the use of objective imaging biomarkers (Type 1 and/or 2 Modic changes) and a correlating presentation of pain remain the most useful patient selection factors for BVN RFA.

Keywords: Disc Degeneration; Endplate; Imaging; Low Back Pain; Vertebral.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Cohort Studies
Humans
Intervertebral Disc Degeneration* / diagnostic imaging
Intervertebral Disc Degeneration* / surgery
Intervertebral Disc*
Low Back Pain* / diagnostic imaging
Low Back Pain* / pathology
Low Back Pain* / surgery
Lumbar Vertebrae / diagnostic imaging
Lumbar Vertebrae / pathology
Lumbar Vertebrae / surgery
Magnetic Resonance Imaging
Prospective Studies
Treatment Outcome