Basivertebral Nerve Ablation (Intracept™)

Chronic low back pain remains one of the most common and disabling conditions. For a significant subset of patients, the pain originates not from the disc, facet joints or spinal nerves, but from the vertebral endplates themselves — a condition known as vertebrogenic pain.

Boston Scientific’s Intracept™ Procedure (basivertebral nerve ablation) is the first therapy specifically designed and proven to target this pathway. Precise, image-guided radiofrequency energy ablates the basivertebral nerve (BVN) inside the vertebral body, interrupting pain signals from inflamed or damaged endplates.

Dr Hao Xiang, Dr Chandra Annabattula, Dr Glen Schlaphoff and Dr Anthony Logaraj have completed specialist training on the Boston Scientific system, and Spectrum Interventional Radiology will introduce the procedure to Australia with first cases in July 2026 — adding to vertebroplasty as a tool for anterior column, endplate and discogenic pain.

What Is Vertebrogenic Pain?

The basivertebral nerves enter the back of each vertebral body through a small nutrient channel, then branch to supply the upper and lower endplates. When the endplates are irritated by adjacent disc degeneration, micro-instability or inflammation, these nerves carry the pain signal centrally.

On MRI this shows up as Modic Type 1 or Type 2 changes — bone marrow oedema and inflammatory change along the endplates. In these patients the endplate–BVN axis can be a potent pain generator, which explains why many continue to have significant pain despite facet radiofrequency neurotomy, epidural injections or other treatments: the true source has not been addressed. Vertebrogenic pain is distinct from — but can coexist with — facet-mediated, discogenic and radicular pain.

How the Procedure Works

Intracept is minimally invasive, implant-free and typically a day procedure. Under sedation or general anaesthesia, a narrow channel is created through the pedicle of each target vertebra (usually between L3 and S1) using purpose-built instruments, guided by real-time imaging.

A radiofrequency probe is advanced to the basivertebral nerve target zone within the vertebral body, and controlled energy is delivered for several minutes to ablate the nerve and its branches. One or more levels can be treated in a single session. The instruments are removed, the small incisions closed, and most patients go home the same day or after overnight observation.

Importantly, the procedure preserves spinal stability and does not close the door on any future surgical options.

The Evidence

Basivertebral nerve ablation is supported by Level 1 evidence — prospective, randomised, sham-controlled trials with follow-up beyond five years, making it one of the most durable minimally invasive options for this specific pain type.

• In the SMART trial (randomised, sham-controlled), treated patients had significantly greater improvement in pain and function than the sham group — and the benefit was sustained: at five or more years, average pain scores had fallen by 4.4 points (from 6.7 to 2.4) and disability scores by 26 points, with about one in three patients pain-free.
• A pooled five-year analysis of 249 treated patients across three prospective trials found an average pain reduction of 4.3 points, a 28-point improvement in Oswestry Disability Index, and — among patients taking opioids at baseline — 65% no longer taking them at five years.
• Safety: serious device- or procedure-related complications occurred in fewer than 0.3% of cases across the studies, with no serious device-related events in the long-term follow-up.

Who Is a Candidate?

The procedure is intended for patients with chronic low back pain of at least six months’ duration that has not responded to six months or more of conservative care (physiotherapy, medications, activity modification, injections), whose MRI shows Modic Type 1 or Type 2 changes between L3 and S1, and whose other potential pain sources — facet arthropathy, sacroiliac joint pain, radiculopathy — have been evaluated and addressed or excluded as the dominant driver.

Relative contraindications include active infection, unstable spondylolisthesis, severe osteoporosis with high fracture risk, and malignancy. Careful imaging review and clinical correlation by an experienced interventional radiologist is essential; diagnostic intraosseous blocks can help in equivocal cases.

Recovery mirrors our other ablation procedures: mild back soreness for several days managed with simple analgesia, return to light activities within days, and progressive improvement over weeks to months as the ablation effect stabilises.

Coming to Spectrum — Next Steps

Basivertebral nerve ablation fills an important gap in our advanced pain programme alongside radiofrequency neurotomy, cryoneurolysis and trans-arterial micro-embolisation (TAME) — and our team’s deep experience in intraosseous and ablative techniques ensures precise targeting of the BVN.

Patients: if you have chronic low back pain with Modic changes on MRI and conservative measures haven’t helped, ask your GP or specialist for a referral to Spectrum Interventional Radiology for assessment.

Referrers: please include a recent lumbar MRI (ideally with Modic changes reported) and a summary of treatments trialled. We are happy to discuss individual cases and review imaging. Medicare item numbers and coverage for this new procedure continue to evolve — please confirm current arrangements with our rooms.

First procedures are planned for July 2026, with training courses to follow. To register your interest, contact our team or Boston Scientific directly.