Department of Orthopedics, University Health-Lakewood Medical Center, Kansas City, Missouri.
Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee.
Pain Med. 2022 Oct 29;23(11):1858-1862. doi: 10.1093/pm/pnac088.
Emerging literature supports the use of basivertebral nerve ablation (BVNA) for a specific cohort of patients with chronic low back pain and Type 1 or Type 2 Modic changes from vertebral levels L3-S1. The early literature warrants further evaluation. Studies establishing the efficacy of BVNA use highly selective patient criteria.
Provide a first estimate of the prevalence of BVNA candidates in a spine clinic over a year using the foundational studies patient selection criteria?
A retrospective review of four fellowhsip trained spine physiatrists patient encounters at a large academic medical center using relevant ICD-10 codes to isolate chronic low back pain without radiating symptoms from January 1, 2019 to January 1, 2020. Charts were then reviewed by a team of physicians for exclusionary criteria from the foundational studies which have demonstrated benefit from BVNA. MRI's from qualifying charts which did not meet exclusionary criteria were then independently reviewed by four physician for localization and characterization of Modic changes.
The relevant diagnostic codes query yielded 338 unique patient records. Based on exclusionary criteria or lack of imaging availability, 318 charts were eliminated. The remaining 20 charts qualified for imaging review. There were 11 charts in which there was 100% agreement between all reviewers regarding the presence and either Type 1 or Type 2 Modic changes between vertebral levels L3 to S1. Accordingly, the prevalence of eligibility for BVNA was 3% (11/338, 95% CI 1-5%).
The population which may benefit from BVNA is small. Our study demonstrated that over a year, the prevalence for BVNA candidacy using the foundational studies criteria was 3% (95% CI 1% - 5%). While physicians may be tempted to use less stringent selection criteria in practice, upon doing so they cannot cite the foundational studies as evidence for the outcomes they expect to achieve. Those outcomes will require more studies which formally assess the benefits of BVNA when selection criteria are relaxed.
新兴文献支持使用基底椎旁神经消融术（BVNA）治疗特定人群的慢性下腰痛和 L3-S1 椎体水平的 1 型或 2 型 Modic 改变。早期文献需要进一步评估。研究建立了 BVNA 使用的疗效高度选择性患者标准。
使用基础研究患者选择标准，在一年的时间内，对脊柱诊所中 BVNA 候选者的患病率进行首次估计。
对一家大型学术医疗中心的四位研究员脊柱物理治疗师的患者进行回顾性研究，使用相关的 ICD-10 代码从 2019 年 1 月 1 日至 2020 年 1 月 1 日隔离无放射症状的慢性下腰痛。然后，由一组医生对基础研究中已证明从 BVNA 获益的排除标准进行了审查。未满足排除标准的合格图表的 MRI 由四位医生独立审查，以确定 Modic 变化的定位和特征。
相关诊断代码查询产生了 338 个唯一的患者记录。根据排除标准或缺乏影像学资料，318 份图表被排除。其余 20 份图表有资格进行影像学审查。有 11 份图表的所有医生对 L3 至 S1 椎体之间存在 1 型或 2 型 Modic 改变的存在和类型达成了 100%的一致。因此，BVNA 合格的患病率为 3%（11/338，95%CI 1-5%）。
可能从 BVNA 中获益的人群很小。我们的研究表明，使用基础研究标准，在一年的时间内，BVNA 候选者的患病率为 3%（95%CI 1%-5%）。虽然医生在实践中可能倾向于使用不太严格的选择标准，但这样做后，他们不能引用基础研究作为他们期望实现的结果的证据。当选择标准放宽时，这些结果将需要更多正式评估 BVNA 益处的研究。
