====== Basivertebral nerve ======

[[Relievant Intracept Procedure]]
 
The basivertebral [[nerve]] provides innervation to the trabecular bone of the [[vertebral body]]. The function of this nerve is not known.

The histology of 69 human vertebral bodies from 23 individuals was studied by hematoxylin and eosin staining using a technique that allowed the creation of complete, large histologic sections of individual vertebral bodies. Particular attention was directed toward the documentation of intraosseous nerves. The vertebral bodies were dissected free of soft tissue, and then sectioned using a diamond wafering saw into 3-mm sagittal segments. Sections were then decalcified and whole-mounted in paraffin blocks before tissue sectioning using a very-large-format microtome. One hundred thirty-eight tissue sections were prepared for evaluation. Neurovascular bundles and intraosseous nerves were routinely identified within human vertebral bone. Nerves were noted to enter the vertebral body via the centrally located posterior vascular foramen and were found to accompany the basivertebral vessels. Branches from these nerves coursed to both central and peripheral areas of the vertebral body. Nerves were also documented that entered the vertebral body by penetrating the anterior cortex to course into the marrow. Although previous studies have documented nerves within long bones, and others have described the histology of the intervertebral disc and associated soft tissues, previous literature that documents the innervation of the human vertebral body has been very sparse. The documentation of nerve tissue within normal human vertebrae further supports the proposed role of neuronal factors in the regulation of bone physiology. Furthermore, it is possible that such intraosseous nerves may play a role in the clinical problem of back pain
((Antonacci MD, Mody DR, Heggeness MH. Innervation of the human vertebral body: 
a histologic study. J Spinal Disord. 1998 Dec;11(6):526-31. PubMed PMID: 9884299.
)).

----

The existence and distribution of these intraosseous nerves within the vertebral body were subsequently further detailed by Fras et al. in 2003 
((Fras C, Kravetz P, Mody DR, Heggeness MH. Substance P-containing nerves within
the human vertebral body. an immunohistochemical study of the basivertebral
nerve. Spine J. 2003 Jan-Feb;3(1):63-7. PubMed PMID: 14589248.
))
and Bailey et al. in 2011
((Bailey JF, Liebenberg E, Degmetich S, Lotz JC. Innervation patterns of PGP
9.5-positive nerve fibers within the human lumbar vertebra. J Anat. 2011
Mar;218(3):263-70. doi: 10.1111/j.1469-7580.2010.01332.x. Epub 2011 Jan 12.
PubMed PMID: 21223256; PubMed Central PMCID: PMC3058212.
))
, who also described the source of the intraosseous nerves as the basivertebral nerve (BVN). 

{{:basivertebralnerve.jpg?400|}}

The BVN enters the posterior vertebral body via the basivertebral foramen and arborizes near the center of the vertebral body, sending branches to innervate the superior and inferior [[endplate]]s.

In 2003, Fras et al.
((Fras C, Kravetz P, Mody DR, Heggeness MH. Substance P-containing nerves within
the human vertebral body. an immunohistochemical study of the basivertebral
nerve. Spine J. 2003 Jan-Feb;3(1):63-7. PubMed PMID: 14589248.
))
reported on the presence of Substance P within the BVN, concluding that these nerves have the potential for transmitting pain signals. Subsequently in 2011, Bailey et al.
((Bailey JF, Liebenberg E, Degmetich S, Lotz JC. Innervation patterns of PGP
9.5-positive nerve fibers within the human lumbar vertebra. J Anat. 2011
Mar;218(3):263-70. doi: 10.1111/j.1469-7580.2010.01332.x. Epub 2011 Jan 12.
PubMed PMID: 21223256; PubMed Central PMCID: PMC3058212.
))
showed that the basivertebral nerves are PGP 9.5-positive, establishing their role in pain transmission.

Lotz et al.
((Lotz JC, Fields AJ, Liebenberg EC. The role of the vertebral end plate in low 
back pain. Global Spine J. 2013 Jun;3(3):153-64. doi: 10.1055/s-0033-1347298.
Epub 2013 May 23. Review. PubMed PMID: 24436866; PubMed Central PMCID:
PMC3854605.
))
documented increased innervation, via the basivertebral nerve, of the endplates with damaged and degenerated endplates. Vertebral body pathology, such as degenerated endplates, 

===== Case series =====
Fourteen patients with CLBP, greater than 6 months, unresponsive to at least 4 months of conservative care were enrolled. All patients were treated successfully following screening using [[MRI]] findings of [[Modic]] type I or II changes and positive confirmatory provocative [[discography]] to determine the affected levels. All patients underwent ablation of the [[basivertebral nerve]] (BVN) using 1414 nm Nd:YAG laser-assisted energy guided in a transforaminal epiduroscopic approach. Macnab's criteria and visual analog scale (VAS) score were collected retrospectively at each follow-up interval.

The mean age was 46 ± 9.95 years. The mean symptoms duration was 21.21 ± 21.87 months. The mean follow-up was 15.3 ± 2.67 months. The preoperative VAS score of 7.79 ± 0.97 changed to 1.92 ± 1.38, postoperatively (P < 0.01). As per Macnab's criteria, seven patients (50%) had excellent, six patients (42.85%) had good, and one patient (7.14%) had fair outcomes.

The transforaminal epiduroscopic basivertebral nerve laser ablation (TEBLA) appears to be a promising option in carefully selected patients with CLBP associated with the Modic changes
((Kim HS, Adsul N, Yudoyono F, Paudel B, Kim KJ, Choi SH, Kim JH, Chung SK, Choi
JH, Jang JS, Jang IT, Oh SH. Transforaminal Epiduroscopic Basivertebral Nerve
Laser Ablation for Chronic Low Back Pain Associated with Modic Changes: A
Preliminary Open-Label Study. Pain Res Manag. 2018 Aug 14;2018:6857983. doi:
10.1155/2018/6857983. eCollection 2018. PubMed PMID: 30186540; PubMed Central
PMCID: PMC6112211.
)).