{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T18:28:33Z","timestamp":1791829713450,"version":"4.3.4"},"reference-count":44,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:00:00Z","timestamp":1782086400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Vertebrogenic low back pain (LBP) is a distinct subtype of chronic LBP (cLBP) arising from nociceptive sensitization of the basivertebral nerve (BVN) within pathologically altered vertebral endplates. Modic type 1 and type 2 changes on MRI are primary imaging biomarkers for patient selection. Basivertebral nerve ablation (BVNA), a minimally invasive intraosseous radiofrequency procedure, has emerged as a targeted treatment for this condition. This narrative review aims to synthesize current evidence on the pathophysiology of vertebrogenic LBP, patient selection criteria, procedural outcomes, safety profile, and cost-effectiveness of BVNA. Methods: We conducted this narrative review of the literature, encompassing randomized controlled trials (including the SMART and INTRACEPT studies), prospective registries, and real-world cohort studies evaluating BVNA for vertebrogenic LBP. Clinical and imaging-based selection criteria, procedural techniques, outcome measures, adverse events, opioid utilization, and healthcare utilization data were examined. Results: Evidence demonstrates consistent and durable reductions in pain and disability following BVNA, with a favorable safety profile. Complication rates are low, with vertebral compression fracture and procedure-related radicular pain reported as the most frequent adverse events. BVNA is associated with reduced opioid consumption and decreased overall healthcare utilization. Moreover, emerging data suggest efficacy beyond originally defined inclusion criteria, including cases of osteoporosis, multilevel Modic changes, adult spinal deformity, and complex comorbid presentations. Conclusions: BVNA represents an effective and safe treatment option within the multimodal management of vertebrogenic LBP. Current evidence supports a gradual expansion of procedural indications, with implications for healthcare resource optimization and opioid stewardship.<\/jats:p>","DOI":"10.3390\/diagnostics16121943","type":"journal-article","created":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T06:13:37Z","timestamp":1782195217000},"page":"1943","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Vertebrogenic Low Back Pain and Basivertebral Nerve Ablation: A Review of Mechanisms, Imaging-Driven Selection, and Clinical Outcomes"],"prefix":"10.3390","volume":"16","author":[{"given":"Daniele G.","family":"Romano","sequence":"first","affiliation":[{"name":"Department of Diagnostic and Interventional Neuroradiology, Ospedali Riuniti San Giovanni di Dio e Ruggi d\u2019Aragona, 84131 Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0795-4233","authenticated-orcid":false,"given":"Ludovica","family":"Liguori","sequence":"additional","affiliation":[{"name":"Department of Medicine and Health Science \u201cV. Tiberio\u201d, University of Molise, 86100 Campobasso, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Pacella","sequence":"additional","affiliation":[{"name":"Department of Medicine and Health Science \u201cV. Tiberio\u201d, University of Molise, 86100 Campobasso, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raffaele","family":"Natella","sequence":"additional","affiliation":[{"name":"Department of Medicine and Health Science \u201cV. Tiberio\u201d, University of Molise, 86100 Campobasso, Italy"},{"name":"Fondazione Trotula de Ruggiero, 84121 Salerno, Italy"},{"name":"Biomedical Research Centre, Gruppo Forte, 84124 Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1444-2585","authenticated-orcid":false,"given":"Federico","family":"Bruno","sequence":"additional","affiliation":[{"name":"Department of Biotechnological and Applied Clinical Sciences, University of L\u2019Aquila, 67100 L\u2019Aquila, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7793-1872","authenticated-orcid":false,"given":"Francesco","family":"Arrigoni","sequence":"additional","affiliation":[{"name":"Department of Biotechnological and Applied Clinical Sciences, University of L\u2019Aquila, 67100 L\u2019Aquila, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4024-1309","authenticated-orcid":false,"given":"Michela","family":"Bruno","sequence":"additional","affiliation":[{"name":"Department of Medicine and Health Science \u201cV. Tiberio\u201d, University of Molise, 86100 Campobasso, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Piemonte","sequence":"additional","affiliation":[{"name":"Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari \u201cAldo Moro\u201d, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Fischetti","sequence":"additional","affiliation":[{"name":"Centro Diagnostico Ricerche Radiologiche s.r.l., Via Pierluigi da Palestrina 1, 70056 Molfetta, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Brunese","sequence":"additional","affiliation":[{"name":"Department of Precision Medicine, University of Campania \u201cL.Vanvitelli\u201d, 80138 Napoli, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4867-5344","authenticated-orcid":false,"given":"Marcello","family":"Zappia","sequence":"additional","affiliation":[{"name":"Department of Medicine and Health Science \u201cV. Tiberio\u201d, University of Molise, 86100 Campobasso, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2801","DOI":"10.2147\/JPR.S378544","article-title":"Best Practice Guidelines on the Diagnosis and Treatment of Vertebrogenic Pain with Basivertebral Nerve Ablation from the American Society of Pain and Neuroscience","volume":"15","author":"Sayed","year":"2022","journal-title":"J. Pain Res."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"van Os, W.K.M., Alvarez-Jimenez, R., Cohen, S.P., Stojanovic, M.P., Ruiz-Lopez, R., Van Zundert, J., and Kallewaard, J.W. (2025). Discogenic Low Back Pain. Pain Pract., 25.","DOI":"10.1111\/papr.70062"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Koreckij, T., Kreiner, S., Khalil, J.G., Smuck, M., Markman, J., and Garfin, S. (2021). 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Res."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/12\/1943\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T06:36:35Z","timestamp":1782369395000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/12\/1943"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,22]]},"references-count":44,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["diagnostics16121943"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16121943","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,22]]}}}