About vertebrogenic low back pain
Each vertebra has a thin plate of bone and cartilage on its top and bottom, where it meets the neighboring disc. When those endplates are damaged or inflamed, often alongside disc wear, the basivertebral nerve inside the vertebra can carry pain signals.
This type of pain is usually felt in the center of the low back and tends to be long-standing. It is identified on MRI by specific changes in the bone next to the disc, called Modic changes, which helps separate it from other sources of back pain.
Seek urgent care if back pain comes with fever, unexplained weight loss, a history of cancer, loss of bladder or bowel control, or new leg weakness.
Common symptoms
- Chronic, central low back pain lasting many months
- Pain that worsens with sitting, bending, or lifting
- Pain with physical activity that limits work or exercise
- Little or no leg pain compared with back pain
Common causes and risk factors
- Wear and damage of the vertebral endplates, often with disc degeneration
- Repetitive heavy loading of the spine over many years
- Prior back injuries
- Inflammation in the bone next to a worn disc
How we diagnose it
Dr. Chen reviews your history and examines the spine, hips, and nerves to rule out other causes. MRI is essential, because vertebrogenic pain is diagnosed by specific type 1 or type 2 Modic changes at the vertebral endplates. These findings, combined with long-standing central back pain that has not responded to rehab, determine whether basivertebral nerve ablation is a reasonable option.
How Propel treats vertebrogenic low back pain
We begin with a structured rehab program built on progressive strength and gradual exposure to the activities that hurt, along with attention to sleep and daily load. This helps many people, and it builds a foundation that supports any procedure later.
For people with the right MRI findings whose pain continues despite at least several months of good conservative care, Dr. Chen may recommend basivertebral nerve ablation, known as Intracept. It is an outpatient procedure that uses a small probe to heat and quiet the nerve inside the vertebra, and it is typically performed in a facility with image guidance and sedation.
What to expect at your visit
- 1.
We listen first
Your visit opens with a real conversation: how the problem started, what you have already tried, and the activity you want back.
- 2.
Exam and in-office ultrasound
A hands-on exam, then ultrasound at the exam table, often while you move, so your physician can see the tendon, joint, or nerve involved.
- 3.
A clear diagnosis and plan
You leave knowing what is wrong and what your options are, from strength-based rehab to procedures, and why we recommend each one.
- 4.
Treatment and follow-through
Most procedures happen here in the office. We coordinate with your physical therapist and check progress against the goals you set.
Questions about vertebrogenic low back pain
- What are Modic changes?
- Modic changes are patterns seen on MRI in the bone right next to a disc. Type 1 and type 2 changes are linked to endplate damage and inflammation and help identify vertebrogenic pain.
- How is Intracept performed?
- Intracept is an outpatient procedure done with image guidance, usually with sedation. A small probe is passed into the vertebra through a tiny opening in the back, and controlled heat quiets the basivertebral nerve. Most people go home the same day.
- Is rehab still needed after Intracept?
- Yes. Rehab is encouraged afterward, and many people find it easier to progress their strength training once pain is lower. We help plan a gradual return to work, exercise, and sport.