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Basivertebral nerve ablation meets neurointervention—déjà vu?
  1. Joshua A Hirsch1,
  2. Diane M Sahr2,
  3. Allan L Brook3,
  4. Ronil V Chandra4,
  5. Luigi Manfre5,
  6. Stefano Marcia6,
  7. James Milburn7,
  8. Mario Muto8
  1. 1Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
  2. 2Perceive Medical LLC, Minneapolits, Minnesota, USA
  3. 3Director of Interventional Neuroradiology, Montefiore Medical Center, Bronx, New York, USA
  4. 4Interventional Neuroradiology, Monash Medical Center and Monash University, Clayton, Victoria, Australia
  5. 5ESNR Secretary of State, Department Head Minimally Invasive Spine, IOM Mediterranean Oncology Institute, Viagrande-Cantania, Sicily, Italy
  6. 6Departmento dei servizi, Radiologia Area Ospedaliera ASL Cagliari, SS Trinita Hospital, Cagliari, Sardinia, Italy
  7. 7Department of Radiology, Ochsner Medical Center, New Orleans, Louisiana, USA
  8. 8Chairman Diagnostic and Interventional Radiology, Cardarelli Hospital, Naples, Italy
  1. Correspondence to Dr Joshua A Hirsch, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA; hirsch{at}snisonline.org

https://doi.org/10.1136/jnis-2024-021484

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    The neurointerventional (NI) community’s development of vertebroplasty parallels the more recent introduction of a novel therapy for the treatment of axial low back pain (LBP) caused by vertebral endplate degeneration. In 1997, Jensen et al published a seminal paper on vertebroplasty for the treatment of vertebral compression fractures caused by osteopenia/osteoporosis, which had impacts well beyond the authors of that small series could have initially imagined.1 Additional research, much of it performed by the NI surgery community, described the safety and efficacy of this procedure in patients with insufficiency or malignant compression fractures.2–4 Researchers speculated on the effects of the heat derived from the bone cement as it pertains to the destruction of tissue including nerve tissue as a source of pain alleviation.5

    During this same timeframe when vertebroplasty was gaining traction, researchers were learning more about the innervation of the vertebral body and disc. Many investigators initially thought that anterior LBP was related to the intervertebral disc. With further evidence on the lack of innervation of the disc, and the discovery of pain receptors located at damaged vertebral end plates with nociception transmitted by a nerve located within the vertebral body, focus shifted to the vertebral body as a potential source of anterior column pain.6–8

    The vertebral endplate is a bilayer of cartilage and bone separating the intervertebral discs and the adjacent vertebrae.8 The endplate distributes intradiscal pressures onto the adjacent vertebrae and serves as a primary pathway for nutrient transport between vertebral capillaries and cells within the disk nucleus. The endplate’s dual roles of nutritional support for the disc and structural support for the spine are at odds, making it vulnerable to damage. With aging and disc degeneration, vertebral endplates thin and calcify leading to increased tensile strain and cracking.

    Endplate subchondral bone …

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    Footnotes

    • X @JoshuaAHirsch

    • Collaborators Not applicable.

    • Contributors JH, MD substantially contributed to the concept, drafting, and critical review of this commentary. DS, BSN substantially contributed to the concept, drafting, and critical review of this commentary. AB, MD substantially contributed to the drafting and critical review of this commentary. RC, MD substantially contributed to the drafting and critical review of this commentary. LM, MD substantially contributed to the drafting and critical review of this commentary. SM, MD substantially contributed to the drafting and critical review of this commentary. JM, MD substantially contributed to the drafting and critical review of this commentary. MM, MD substantially contributed to the drafting and critical review of this commentary. All the authors provided final approval of the version to be published and agree to be accountable for all aspects of the article in ensuring that questions related to the accuracy or integrity of any part of the commentary are appropriately investigated and resolved per the ICMJE guidelines for authorship.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests The following authors have disclosures: Joshua A Hirsch - consultant for Medtronic, Relievant Medsystems, Sanofi, Data Management Committee chair for Balt, Rapid Medical, and Grant recipient for Neiman Health Policy Institute; Diane M Sahr - consultant for Relievant Medsystems and Sollis Therapeutics; Allan Brook - consultant for NEVRO, Medtronic, Vizo, Alio; Ronil V Chandra - advisor/consultant for Remedy Robotics; Stefano Marcia - consultant for Stryker and Techlamed; James Milburn - consultant for Microvention, consultant and steering committee member for Imperative Care Inc, and Scientific Advisory Committee for Optimize Neurovascular. The following authors have no disclosures: Luige Manfre and Mario Muto.

    • Provenance and peer review Not commissioned; externally peer reviewed.