Mixed-Duration Basivertebral Nerve Ablation for Vertebrogenic Low Back Pain: Lesion Strategies and Clinical Outcomes in a Multicenter Retrospective Cohort Study

Pain Med. 2026 Apr 21:pnag057. doi: 10.1093/pm/pnag057. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate whether lesion duration, aka "burn time" is associated with clinical outcomes following basivertebral nerve ablation (BVNA).

DESIGN: Multicenter retrospective cohort study.

SETTING: Seven United States pain management and spine care centers including academic, community, and private practice settings.

SUBJECTS: 359 adults with vertebrogenic low back pain (LBP) of at least 6 months' duration with magnetic resonance imaging evidence of Modic Type I or Type II vertebral endplate changes who underwent BVNA between 2022 and 2025.

METHODS: Patients were categorized into three groups according to radiofrequency lesion duration: Uniform 7-minute lesions (n = 202), uniform 15-minute lesions (n = 59), or mixed-duration lesions combining 7- and 15-minute applications (n = 98). Pain intensity was assessed using the Numeric Rating Scale at baseline and at 1, 3, and 6 months. The primary outcome was ≥50% pain reduction at 6 months. Secondary outcomes included ≥30% and ≥80% improvement and continuous pain change. Multivariable analyses incorporated propensity score-based inverse probability of treatment weighting (IPTW) to adjust for baseline demographic, clinical, and anatomical covariates. Sensitivity analyses included complete-case and worst-case scenarios, as well as alternative IMMPACT-aligned responder thresholds.

RESULTS: Responder rates differed across groups, with 54.0% in the 7-minute group, 59.3% in the 15-minute group, and 73.5% in the mixed-duration group (p = 0.005). In propensity-weighted analyses, mixed-duration lesioning showed higher odds of ≥ 50% response compared with uniform 15-minute lesions, but this difference did not reach statistical significance (OR 2.01; 95% CI 0.88-4.59; p = 0.098), while 15-minute lesioning showed no clear advantage over 7-minute lesions. Continuous measures of pain improvement did not differ across groups. Male sex was associated with lower response, whereas baseline pain severity, symptom duration, and number of treated levels were not. Findings were consistent across sensitivity analyses and alternative responder thresholds.

CONCLUSIONS: In this multicenter cohort, mixed-duration BVNA was associated with higher responder rates than uniform lesion strategies, but no statistically significant differences in outcomes were observed across 7-minute, 15-minutes, or mixed duration strategies after adjustment. The observed variation in lesion strategies underscores the need for prospective studies to evaluate tailored lesioning approaches.

CLINICAL TRIAL REGISTRATION: This study was a retrospective observational cohort study and was not registered in a clinical trials registry.

PMID:42015883 | DOI:10.1093/pm/pnag057