At Buckinghamshire Private Healthcare we proudly support the Research and Innovation Centre at Buckinghamshire Healthcare NHS Trust as we are able to provide our patients with innovative, research based alternatives to current procedures that may enhance patient outcomes. We recently spoke with Dr David McKean, Consultant Musculoskeletal Radiologist on a new Pain Management procedure that he will be offering to patients from our hospital locations in Buckinghamshire. We wanted to get an idea on why this procedure might be suggested to a patient suffering from chronic pain and what their journey to becoming pain free make look like.
Can you provide a summary to start us off, what is this procedure and what does it involve?
Basivertebral nerve ablation is a minimally invasive treatment for patients with certain types of chronic low back pain, specifically, vertebrogenic back pain. Now this occurs when there’s damage to the end plates within your vertebra. The damaged end plates can trigger pain at the basivertebral nerve inside your vertebrae, and the basivertebral nerve ablation procedure uses radiofrequency energy to heat a small point next to the nerve, which will disrupt the pain signals that travel from your spine to your brain, offering relief from vertebrogenic back pain.
Why might this procedure be offered?
Clinicians will often recommend basivertebral nerve ablation when non-surgical options like medication, injections or physiotherapy have not been effective enough. One of the positives is that this is a less invasive alternative to spinal surgery. This procedure is a minimally invasive day case procedure that can be performed under sedation and using local anaesthetic rather than the patient needing to undergo general anaesthetic.
Who may patients have already seen before discussing this procedure?
Patients would initially be seen by one of our fantastic pain physicians who would confirm whether or not they are suitable candidates for this procedure. If they are suitable and they meet our inclusion criteria, we would arrange for a date for them to come into the radiology department.
Can you talk through the patient journey for this procedure?
When you come in for this procedure, you’ll be brought into the radiology department and once you’re in the interventional suite, you’ll be given some sedation which can make patients feel quite sleepy, along with pain relief medications. You’ll be lying face down on the table in the interventional room and then using X-ray guidance, a small hollow tube will be placed within the vertebrae and a small probe will be positioned next to the basivertebral nerve. The probe is then used to apply radiofrequency energy to heat up the tissues next to the nerve, which will lead to a disruption of the pain signals travelling to your brain.
After this, the instruments are all removed, and the small incision is closed before taking the patient back to a recovery room for a couple of hours. It’s a day case procedure and patients are able to go home a few hours later.
Most people would make a full recovery following the procedure in one or two weeks, you might be able to return to work as early as two- or three-days following the procedure, but if you have a physically demanding job, you might want to take a few more days off.
A follow up appointment would then be arranged with the initial pain physician who saw you, at about six weeks after the procedure to assess whether or not it has been successful and then to discuss any other treatment options that might be necessary.
We learnt from yourself and your colleagues that pain can be quite subjective. So, is this procedure suitable for a range of people, or is it recommended for a specific sub-group of patients?
This treatment is only suitable for a quite specific group of patients. This would be patients with chronic low back pain that has not responded to other treatments for at least six months. You also need to have had an MRI (Magnetic Resonance Imaging) previously which shows inflammation of the vertebra to confirm the site of symptoms and all patients would have to be assessed by one of our fantastic pain physicians to confirm that there are suitable candidates for this procedure beforehand.
Are there benefits over other treatments?
The procedure is minimally invasive, it can be very effective for the right patients, and it can have very long-lasting results. In one study in 2023, about 65% of patients reported at least a 50% reduction in their back pain, about 36% of patients reported at least a 75% reduction in their back pain and around 22% patients reported a 100% reduction in their back pain at six months following the procedure. However, this procedure does not work for everyone, and some patients may go on to see a spinal surgeon to discuss further treatments.
Should any risks be considered?
While complications aren’t common, they can happen after any intervention procedure and possible basivertebral nerve ablation complications would include bleeding, infection, nerve damage, or sometimes increased back pain. But these are very uncommon complications.
This is an innovative treatment that we are able to offer, do you have any further comments that you wish to add for patients that might be looking to have this procedure performed?
Well, I think this is a very exciting treatment to make available to patients, especially when they often have very few options at this point if they haven’t responded to conservative management and physiotherapy. If we are able to relieve patients’ pain and spare them having to go on to have spinal surgery, then that is a fantastic result. For appropriately selected patients, this can be a very effective treatment.
Have a question or want to get in touch?
We offer a range of specialist private health services, delivered by specialist clinicians, across three Buckinghamshire locations, including High Wycombe, Amersham and Stoke Mandeville.
