NASS Insider

May 05, 2022

Submit Comments about NASS Coverage Recommendation Basivertebral Nerve Ablation by June 4, 2022

Your input is important. Please review and make comments/suggestions to assist the NASS Coverage Committee with development of the latest coverage recommendation, Basivertebral Nerve Ablation (BNA). This coverage recommendation reflects the best available data as of 7/2/2021; information and data published after 7/2/2021 is thus not reflected in this recommendation and may warrant deviations from this recommendation, if appropriate.

There is a growing evidence that damage to the highly innervated vertebral endplates can result in vertebrogenic pain (VBP) transmitted through branches of the basivertebral nerve (BVN). Radiofrequency ablation of the BVN has emerged as a possible nonsurgical therapy for this condition. Current BVN ablation evidence demonstrates a consistent short to intermediate-term improvements in function and pain. In addition to two prospective single-arm studies reporting clinically significant improvements in Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) from baseline, two level 1 randomized controlled trials (RCTs) have demonstrated superiority over standard care at 3 months and 12 months and over sham control at 12 months.

Basivertebral Nerve Ablation is indicated for patients presenting with lower back pain, when:
  • Patients have chronic lower back pain for at least 6 months
  • Patients have failed to adequately improve despite attempts at nonsurgical management
  • Patients have Type 1 or Type 2 Modic changes on MRI
Basivertebral Nerve Ablation is NOT indicated in ANY of the following scenarios:
  • Metabolic bone disease (e.g., osteoporosis), treatment of spine fragility fracture, trauma/compression fracture or spinal cancer
  • Spine infection or active systemic infection
  • Radiographic evidence of another obvious etiology for the patient’s LBP
  • Patients with severe cardiac or pulmonary compromise
  • Patients with implantable pulse generators (e.g., pacemakers, defibrillators) or other electronic implants unless specific precautions are taken to maintain patient safety
  • Neurogenic claudication, lumbar radiculopathy or radicular pain due to neurocompression (e.g., HNP, stenosis)
  • Evidence of instability identified on flexion and extension X-rays or a grade 2 or greater spondylolisthesis at the segment to be treated
SUBMIT any comments to this proposed document by June 4, 2022 at 5:00pm CST. At the end of the public comment period, comments will be reviewed and considered by the NASS Coverage Committee. Where appropriate, the Committee will make edits and then publish the final coverage recommendation.