Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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July 4, 2024
Intracept Procedure – Radiofrequency Ablation of Basivertebral Nerve
- Background:
- Low back pain is the leading cause of disability worldwide and affects more than 30 million people in the United States.
- There is growing evidence that damaged, innervated vertebral endplates may be the source of back pain, which is transmitted through branches of the basivertebral nerve (BVN).
- Radiofrequency ablation (RFA) of the BVN is a therapeutic option for vertebrogenic low back pain when more conservative management fails to alleviate pain.
- RFA uses a high-frequency electrical current that passes through a needle creating thermal energy at the needle tip. The thermal energy causes coagulation necrosis of the BVN, impeding transmission of pain signals.
- The procedure leaves a small, often less than a centimeter, spherical shaped lesion in the vertebral body, which can be best visualized on the STIR MRI sequence with a central area of low signal (necrotic tissue) and surrounding high signal (granulation tissue or edema). Because the terminus of the BVN is located in the posterior one-half orone- third of the vertebral body, this is where these lesions are typically found.
- Key Diagnostic Features:
- Lesions are typically located in the posterior one-half or one-third of several successive vertebral bodies.
- Lesions typically demonstrate a target-like appearance with high signal peripherally and low signal centrally on STIR sequences, and low signal peripherally and intermediate signal centrally on T1-weighted sequences.
- Missed diagnosis can lead to unnecessary, expensive, and laborious work-up to look for metastatic disease.
- Differential Diagnosis:
- Metastatic lesions that usually spread through the basivertebral plexus such as prostate cancer and colon cancer.
- Treatment:
- No further treatment is required.
- This case demonstrates that radiologists should be aware that postprocedure RFA findings may resemble metastatic disease on MRI.
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