Background & Rationale
Chronic Low Back Pain (CLBP) & Osteoporosis
CLBP is a leading cause of disability in older adults
Vertebral endplate pathologies, including Modic changes, are linked to persistent back pain
BVNA is increasingly used for CLBP but remains relatively contraindicated in osteoporosis (T-score < –2.5)

Knowledge Gap
Few studies document Modic changes post-BVNA in osteoporotic patients
High-risk populations (postmenopausal women, prior spinal surgery) require careful pre-procedural screening

Considerations of Vertebrogenic Lower Back Pain After Basivertebral Nerve Ablation (BVNA) Complicated in a Postmenopausal Woman: Case Report

Case Summary

Patient Overview
63-year-old female with history of OSA, hypertension, GERD, IBS, osteoporosis, prior L3–S1 microdiscectomy
Persistent postsurgical low back pain treated with L3–L5 medial branch RFA and L5–S1 BVNA

Clinical Presentation
Pain: stabbing, burning, tingling; worsened with flexion/extension; radiates to toes
Medications: oxycontin, pregabalin

Imaging Findings
MRI: pronounced central signal changes in L5–S1 post-BVNA; more extensive than typical
Modic-type endplate changes at L5 superior endplate contributing to axial pain

Osteoporosis Confirmation
DEXA: L3 T-score = –3.2 (severe osteoporosis)
Previously diagnosed but formal workup not completed

Discussion & Clinical Implications
Key Points
BVNA is contraindicated in osteoporosis due to fracture risk
Severe bone loss may exacerbate post-ablation vertebral changes
Risk factors include postmenopausal status, prior spinal surgery, and opioid use

Recommendations
Screen high-risk patients before BVNA
Diagnose and treat osteoporosis prior to the procedure
Monitor imaging for post-procedural changes in endplates

Implication
Proper pre-procedural evaluation may reduce complications and improve outcomes in osteoporotic CLBP patients undergoing BVNA

Image 1: Lumbar Spine MRI Sagittal view with red arrows indicating significant post-BVNA changes in the vertebral bodies of L5 (superior) and S1 (inferior)

Severe osteoporosis may worsen vertebral changes after BVNA—screen high-risk patients first