What is basivertebral nerve ablation (Intracept procedure)?

Basivertebral nerve ablation (also known as the Intracept procedure) is a minimally invasive intervention used to treat chronic vertebrogenic (vertebral-origin) low back pain. The pain often originates from damage to the vertebral endplates, which is indicated by Modic type I or type II changes on MRI examination.

During the procedure, the basivertebral nerve (the nerve running inside the vertebral body) is interrupted using radiofrequency heat (ablation), thereby reducing or eliminating the transmission of pain signals to the brain.

When is basivertebral nerve ablation indicated? This procedure is considered when chronic low back pain (present for at least 6 months) has not significantly improved with conservative treatments (medications, physical therapy, injections), and the pain is vertebrogenic in nature (midline low back pain that worsens with sitting, forward bending, or loading).

MRI-confirmed Modic changes are required for diagnosis. The specialist determines the most appropriate treatment based on the patient’s medical history, symptoms, and imaging findings.

What happens during the basivertebral nerve ablation procedure?

The procedure is performed in an operating room, usually under general anesthesia or deep sedation, with real-time fluoroscopic (X-ray) guidance.

  • The patient lies face down.
  • A small incision (approximately 3 mm) is made, through which a specialized cannula is advanced into the vertebral body (transpedicular approach).
  • The cannula reaches the trunk of the basivertebral nerve.
  • A radiofrequency probe is inserted, which heats the nerve (typically at 70–80 °C for several minutes) to ablate it and interrupt pain signal transmission.
  • The probe and cannula are removed, and the small incision is closed sterilely.

The procedure usually takes 60–90 minutes and is most often performed on an outpatient basis (the patient can go home the same day).

When is the procedure not recommended?

The ablation is not advised or is contraindicated in the following cases:

  • Pregnancy
  • Severe heart or lung disease
  • Active pacemaker or defibrillator (certain types)
  • Active local or systemic infection
  • Anatomical variations that would pose a risk to safe access to the nerve
  • Non-vertebrogenic pain (e.g., disc herniation, nerve root compression)
  • Old, stable pain without active Modic changes visible on imaging

What can I expect during the procedure? Due to sedation or general anesthesia, you will not feel pain during the procedure, although the initial seconds of ablation may feel briefly uncomfortable (pain relief and sedation are provided for this reason). Most patients tolerate the procedure very well.

What are the potential risks?

Like any medical procedure, there are possible complications, but they are rare (<1–3%):

  • Temporary pain at the procedure site or in the legs (usually lasts a few days to weeks)
  • Minor bleeding or infection (very rare; antibiotic prophylaxis is often administered)
  • Rarely, nerve irritation, numbness, or weakness
  • Device-related issues (e.g., cannula breakage) – extremely rare

The risk of serious complications is very low, and most side effects are mild and resolve on their own.

How should I prepare for the procedure?

1. Pre-procedure evaluations and consultation

  • An MRI is required to confirm Modic type I or II endplate changes.
  • Full medical evaluation (blood tests, ECG, etc.), discussion of allergies, previous surgeries, and medical conditions.

2. Medications

  • Blood thinners (e.g., Aspirin, Clopidogrel, Warfarin, NOACs such as Xarelto, Eliquis): usually need to be stopped 5–10 days prior – this must always be coordinated by your treating physician (cardiologist/hematologist)!
  • Anti-inflammatory drugs and painkillers: usually can be continued, but confirm with your doctor.
  • In case of diabetes, insulin dosing may need adjustment.
  • Inform your doctor about all medications and dietary supplements!

3. Eating and drinking

  • Do not eat for 6 hours before the procedure.
  • You may drink clear water up to 2 hours before the procedure (due to anesthesia/sedation).
  • Morning medications may be taken with a small sip of water (follow your doctor’s instructions).

4. Other practical advice

  • A companion is mandatory! You will not be allowed to drive on the day of the procedure and must be accompanied home.
  • Wear comfortable clothing (easy to remove upper and lower garments).
  • If you develop fever, feel unwell, or notice signs of infection – notify us immediately; the procedure may need to be postponed!

5. On the day of the procedure

  • Arrive at the scheduled time.
  • Check-in, change clothes, IV line placement, administration of sedative/anesthetic medication.

What can I expect after the procedure?

  • Most patients go home on the same day.
  • Rest is recommended for a few days, but early gentle mobilization (light walking) is encouraged and recommended.
  • Pain relief often begins immediately or within 1–3 weeks, though the full effect may take up to 3–6 months to develop.
  • Short-term use of painkillers and anti-inflammatory medications is common.
  • After a few weeks of spine protection, a gradual, structured physical therapy program is recommended to strengthen muscles and improve function.

How long can the functional improvement and pain relief be expected to last?

Studies show that pain reduction is often durable, lasting for many years (5-year follow-up data also demonstrate significant improvement). The majority of patients experience long-lasting pain relief (up to 70–80% reduction), improved function, and a substantial decrease in the need for pain medications or injections.

The procedure is typically a one-time treatment; the nerve does not regenerate after ablation (unlike facet nerve ablation). Pain may return due to other causes (e.g., new vertebral degeneration), but the effect at the treated level is considered long-lasting.

Important note: This is general patient information only. The suitability of the treatment, exact risks, and expected outcomes are always assessed individually by your treating physician based on examinations and consultation. Please ask your doctor any questions you may have!