North American Spine Society Journal最新文献

{"title":"Section on innovative spine research and novel technologies: fusion cage design, materials, and coatings: Science versus hype1","authors":"Donna D. Ohnmeiss PhD ,&nbsp;David C. Stastny II DO ,&nbsp;Zorica Buser PhD ,&nbsp;Lisa A. Ferrara PhD","doi":"10.1016/j.xnsj.2025.100814","DOIUrl":"10.1016/j.xnsj.2025.100814","url":null,"abstract":"<div><h3>Background</h3><div>Interbody fusion has been performed for many decades with evolving strategies and approaches to improve safety, fusion rates, and clinical outcomes. There have been ongoing advancements in the understanding of spinal biomechanics driving improved implant designs. The advent of 3D printing has allowed new concepts of cage designs to become a reality. The purpose of this narrative review is to provide an overview of current and developing technologies in the area of fusion cage design as well as concerns of the impact of marketing versus science in this area.</div></div><div><h3>Methods</h3><div>A literature search was conducted on PubMed and OVID to identify articles related to interbody fusion cage design. The focus of the review was on current and future interbody fusion cage design.</div></div><div><h3>Results</h3><div>The area of fusion cage design has been rapidly growing. The greatest advancements have been in the area of additive manufacturing which has allowed for much more intricate implant design. Significant advancements have also been made in improving the surfaces of implants to promote osseointegration. Advancements in materials, manufacturing, and sensor technologies are paving the way for developing intelligent interbody fusion cages capable of monitoring fusion progression and potentially stimulating bone growth.</div></div><div><h3>Conclusion</h3><div>There have been many exciting developments in the area of fusion cages, primarily related to materials, design, and surface topology, much of which have been driven by the advent of 3D printing. While many of these technologies may hold promise, there is relatively little data for the particular purported benefits of these implants. Much work is needed to understand the mechanobiological function of these devices, their clinical outcomes, indications, and cost-effectiveness.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100814"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145568781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Guest editors introduction of the North American spine society section reports: state of the art and future directions in spine surgery/care","authors":"Rajiv Saigal MD, PhD ,&nbsp;Zorica Buser PhD, MBA ,&nbsp;Michael G. Fehlings MD, PhD","doi":"10.1016/j.xnsj.2025.100826","DOIUrl":"10.1016/j.xnsj.2025.100826","url":null,"abstract":"","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100826"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145789902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The kiva system versus balloon kyphoplasty for vertebral compression fracture: a meta-analysis of randomized control trials","authors":"Humaid Al Farii MD,&nbsp;Nikhil Gattu MD,&nbsp;Caleb M. Yeung MD,&nbsp;Christopher A. Alvarez-Breckenridge MD,&nbsp;Robert Y. North MD,&nbsp;Claudio E. Tatsui MD,&nbsp;Laurence D. Rhines MD,&nbsp;Valerae O. Lewis MD,&nbsp;Justin E. Bird,&nbsp;Shalin S. Patel","doi":"10.1016/j.xnsj.2025.100778","DOIUrl":"10.1016/j.xnsj.2025.100778","url":null,"abstract":"<div><h3>Background</h3><div>Vertebral compression fractures (VCFs) are the most common type of vertebral body fracture. The Kiva VCF Treatment System is a relatively novel technique to manage VCFs. The aim of this study was to compare the efficacy of Kiva versus standard Balloon Kyphoplasty (BK) through evaluation of published randomized controlled trials (RCTs).</div></div><div><h3>Methods</h3><div>This study was performed following the guidelines for PRISMA. We performed a systematic literature search using PubMed and MEDLINE in June 2023. The search keywords were “Kiva” and “Kyphoplasty” which yielded a total of 112 articles. Outcome measures included pain, measured through the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI), and cement leakage rates.</div></div><div><h3>Results</h3><div>Three RCTs were included in this meta-analysis. A total of 468 patients (Kiva=232 patients and BK=236 patients) and 694 fractures (351 treated with Kiva and 343 treated with BK) were included after fulfilling the inclusion criteria. The VAS score in both the Kiva and BK group improved significantly. There was no difference in VAS improvement between the 2 groups (p-value=.84). Of the 694 fractures that were treated procedurally, the Kiva system had significantly less cement leakage than BK (95% CI [-0.89, -0.22], p-value=.00). However, and collectively out of those who had cement leakage, there was only 2 patients (2.1%) developed adverse events of acute paraplegia required reoperation.</div></div><div><h3>Conclusions</h3><div>This meta-analysis demonstrates that the Kiva system and balloon kyphoplasty are both strong treatment options for the purpose of reducing pain associated with VCFs, whether osteoporotic or metastatic in etiology. However, Kiva system was favorable over balloon kyphoplasty in terms of rates of cement leakage.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100778"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145046902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decreasing utilization of opioids and prescription nonopioids following lumbar discectomy","authors":"Philip P. Ratnasamy BS,&nbsp;Gwyneth C. Maloy BA,&nbsp;John Slevin BS,&nbsp;Arya G. Varthi MD,&nbsp;Jonathan N. Grauer MD","doi":"10.1016/j.xnsj.2025.100793","DOIUrl":"10.1016/j.xnsj.2025.100793","url":null,"abstract":"<div><h3>Background</h3><div>Lumbar discectomy may be considered for lumbar radicular symptoms. There have been recent pushes to reduce opioid use and promote multimodal pain management. This large administrative database study evaluated trends in pain management prescriptions following lumbar discectomy.</div></div><div><h3>Methods</h3><div>Lumbar discectomy patients were identified from the 2010-2021 PearlDiver M165Ortho database. Patients with prior history of substance abuse, neoplasm, or any concomitant anterior or posterior lumbar surgical intervention were excluded. Prescriptions of pain management drugs were evaluated in the 90-days following surgery and manually grouped as opioids and/or other categories of pain management drugs. Prescriptions and morphine milligram equivalents (MMEs) per 1,000 lumbar discectomy surgeries were determined and trended. Multivariable analysis was performed to determine clinical and nonclinical factors independently associated with opioid prescription use.</div></div><div><h3>Results</h3><div>From a total of 93,252 lumbar discectomies meeting inclusion criteria, opioid prescriptions decreased from 531.7 per 1,000 lumbar discectomy surgeries in 2010 to 97.1 in 2021 (-81.7%). Prescriptions of other pain management drugs on aggregate decreased from 527.9 in 2010 to 174.9 in 2021 (-66.9%). The proportion of all analgesics prescribed postoperatively that were opioids decreased from 50.2% in 2010 to 35.7% in 2021. Among patients who received opioids in the 90-days postoperatively, MMEs prescribed per lumbar discectomy case decreased from 262.8 in 2010 to 24.6 in 2021 (-90.7%). Predictors of postoperative opioid prescriptions by multivariate analysis included clinical factors (younger age [OR 1.20 per decade decrease], male sex [OR 1.40], lower ECI [OR 1.16]) and the nonclinical factor of geographic variation (relative to South, Northeast OR 1.08, Midwest OR 1.09) (p&lt;.05 for each).</div></div><div><h3>Conclusions</h3><div>Opioid prescriptions following lumbar discectomy have markedly decreased over the past decade. Notably, nonopioid prescriptions have also decreased, likely in favor of nonprescription multimodal pain management medications and strategies.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100793"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145268457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anterior cement augmentation technique for correction of kyphotic deformity in the lumbar spine using an anterior-to-Psoas approach","authors":"David Shin BS ,&nbsp;David Cheng BS, MPH ,&nbsp;Debra Cheng BS ,&nbsp;Carson Cummings BS ,&nbsp;Jacob Razzouk BS ,&nbsp;Olumide Danisa MD ,&nbsp;Wayne Cheng MD","doi":"10.1016/j.xnsj.2025.100818","DOIUrl":"10.1016/j.xnsj.2025.100818","url":null,"abstract":"<div><h3>Background</h3><div>Posterior kyphotic deformity correction in patients with osteoporosis carries a significant risk of instrumentation cut-out. Anterior approaches allow direct distraction at the center of the deformity, yet reduction devices or instrumentation may telescope into vertebral endplates. This study proposes an anterior cementing augmentation technique for correction of kyphotic deformity involving a less invasive oblique lateral interbody fusion (OLIF) approach.</div></div><div><h3>Case description</h3><div>Patient 1 had a previous compression fracture at L2 above prior instrumented fusion, with kyphotic deformity, and underwent a stage-one anterior lateral L2 corpectomy via an (OLIF) approach. Cement was placed centrally at L1 and L3, followed by an expandable cage and a stage-two posterior T11-to-pelvis instrumented fusion with prophylactic cement augmentation at T10–T12. Patient 2 had a previous remote L5–S1 anterior lumbar interbody fusion and underwent a posterior C4–S1 osteotomy and instrumented fusion for kyphoscoliosis deformity. The patient developed immediate postoperative instrumentation failure with kyphosis at L4–L5 and instrumentation loosening and migration at L4–S1 within 2 weeks of surgery. They then underwent (OLIF) at L4–L5 with anterior cement augmentation at L4–L5, followed by a revision lumbar-pelvic instrumented fusion.</div></div><div><h3>Outcome</h3><div>A step-by-step technique was described for anterior corpectomy and cement augmentation via an anterior lateral approach, presenting an alternative for correction of kyphotic deformity and restoration of sagittal alignment in the lumbar spine of patients with poor-bone density.</div></div><div><h3>Conclusions</h3><div>A minimally invasive, anterior-to- psoas approach may decrease morbidity of approach related complications. Both patients demonstrated kyphotic deformity correction with follow-up records suggesting favorable outcomes.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100818"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145614555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with transforaminal epidural steroid injection efficacy and prognosis for symptomatic treatment of lumbar stenosis associated with degenerative scoliosis","authors":"Tyler MacNeil BA ,&nbsp;Owen Karsmarski MD ,&nbsp;Amanda Spraggs-Hughes PhD ,&nbsp;Isaac L. Moss MD ,&nbsp;Durgadas P. Sakalkale MD","doi":"10.1016/j.xnsj.2025.100807","DOIUrl":"10.1016/j.xnsj.2025.100807","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Although transforaminal epidural steroid injections (TFESIs) have been very commonly used for symptomatic treatment in patients with lumbar spinal stenosis, there is a paucity of literature on their use in patients with stenosis associated with degenerative lumbar scoliosis. There have been various published studies on parameters affecting the outcome of TFESIs, however there are no studies focusing on the effects of anatomical parameters associated with lumbar scoliosis on the outcome of these injections. The primary goal of this study is to assess anatomical and structural factors affecting efficacy of TFESI in the treatment of patients with lumbar degenerative scoliosis. A secondary goal of this study is to assess whether positive response with TFESI could predict better outcomes of subsequent lumbar surgery.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This is a retrospective cohort study involving patients who were treated at an academic medical center. The patient sample is made of 149 patients with degenerative lumbar scoliosis who underwent TFESI during the time period of 2018 to 2023 for symptoms of axial and radicular pain. 19 of these patients underwent subsequent lumbar surgery. Scoliosis was defined as having a Cobb’s angle of at least 20 degrees. The primary outcome measure is TFESI efficacy, assessed by the difference in pain on the numerical rating scale (NRS, score 0–10) for patients between score before TFESI and score at minimum 2 weeks after the injection. A minimal clinically important difference (MCID) was defined as net change in NRS ≥2.0 to identify the patients with a clinically significant reduction in pain level. A secondary outcome measure is subjective clinical improvement or lack thereof for patients after lumbar surgery. Variables analyzed to assess TFESI efficacy include laterality of injections with respect to the primary lumbar curve, distance of an injection to the apex of the primary lumbar curve, severity of Cobb’s angle, severity of stenosis, and degree of spinal lateral listhesis. Lumbar surgery success was compared between patients who had either previously achieved or had not achieved MCID with TFESI. Statistical analyses included Chi-Square tests, Fisher exact tests, and a linear regression.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;We found an improvement in TFESI efficacy for injections completed on the convex-side of the primary scoliosis curve over concave-side when patients had radicular pain at the L5-S1 spinal level (likelihood ratio with convex-side injection 0.21, likelihood with concave-side injection 0.80; p = .037). Trends were also observed for convex-side injections overall and for lower levels of lateral listhesis over higher levels to be associated with improved efficacy, and there was a 100% positive predictive value for prior successful TFESI to predict lumbar surgery success. No significant impact of severity of Cobb’s angle nor severity of stenosis were noted on the out","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100807"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145416313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of prediabetes on postoperative outcomes following short-segment transforaminal lumbar interbody fusions","authors":"Syed I. Khalid MD ,&nbsp;Ryan Wang BS ,&nbsp;Jakov Tiefenbach MD ,&nbsp;Tatiana Abou-Mrad MD ,&nbsp;Elie Massaad MD, MSc ,&nbsp;Aladine Elsamadicy MD ,&nbsp;Ankit I. Mehta MD ,&nbsp;John H. Shin MD, MBA","doi":"10.1016/j.xnsj.2025.100811","DOIUrl":"10.1016/j.xnsj.2025.100811","url":null,"abstract":"<div><h3>Objectives</h3><div>Type 2 diabetes mellitus (T2DM) is a well-established risk factor for adverse surgical outcomes, but the impact of prediabetes on spine surgery remains unexplored. This study evaluated the influence of prediabetes on postoperative complications in patients undergoing short-segment (≤3 levels) transforaminal lumbar interbody fusion (TLIF).</div></div><div><h3>Methods</h3><div>We retrospectively reviewed patients undergoing 1-3 level TLIF in a national administrative database. Patients were categorized into 3 groups: no diabetes, prediabetes, and T2DM. Patients with type 1 diabetes were excluded. A 1:1:1 exact match was performed to balance demographics, comorbidities, and the number of spinal levels fused. Thirty-day postoperative medical and surgical complications were analyzed.</div></div><div><h3>Results</h3><div>A total of 17,796 patients (5,932 per group) were included. Patients with T2DM demonstrated a significantly higher incidence of urinary tract infection (OR, 1.49; 97.5% CI, 1.19–1.86), pneumonia (OR, 1.59; 97.5% CI, 1.10–2.31), acute kidney injury (OR, 2.32; 97.5% CI, 1.70–3.18), surgical site infection (OR, 1.34; 97.5% CI, 1.04–1.74), overall medical complications (OR, 1.50; 97.5% CI, 1.28–1.75), and surgical complications (OR, 1.29; 97.5% CI, 1.05–1.58). In contrast, patients with prediabetes did not demonstrate a statistically significant increase in postoperative complications.</div></div><div><h3>Conclusions</h3><div>T2DM is associated with a higher risk of medical and surgical complications following short-segment TLIF. However, prediabetes does not appear to affect postoperative complication rates. These findings suggest enhanced perioperative management is warranted for patients with T2DM, while standard protocols may be sufficient for patients with prediabetes.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100811"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145416314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the editor regarding chemical prophylaxis and venous thromboembolism following elective spinal surgery: a systematic review and meta-analysis","authors":"Zahra Ramezani MD,&nbsp;Seyed Danial Alizadeh MD,&nbsp;Vafa Rahimi-Movaghar MD","doi":"10.1016/j.xnsj.2024.100311","DOIUrl":"10.1016/j.xnsj.2024.100311","url":null,"abstract":"","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100311"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139639301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting rehabilitation discharge after lumbar decompression: Impact of age and preoperative assistive device use","authors":"Michael Avery MD, PhD ,&nbsp;Fernando Terry MD ,&nbsp;Andrew Y. Powers MD, MBI,&nbsp;Forough Yazdanian MD,&nbsp;Chloe Lee BS,&nbsp;Punit Pandya DO,&nbsp;Martina Stippler MD,&nbsp;Efstathios Papavassiliou MD,&nbsp;Ziev B. Moses MD","doi":"10.1016/j.xnsj.2025.100815","DOIUrl":"10.1016/j.xnsj.2025.100815","url":null,"abstract":"<div><h3>Background</h3><div>Elective lumbar decompression, commonly performed via laminectomy or microdiscectomy, is a well-tolerated surgical procedure. Patients requiring discharge to inpatient rehabilitation facilities are infrequent but generate increased healthcare costs and can be burdensome to patients and families. This study aims to develop an accurate predictive model for rehabilitation discharge following elective lumbar decompression, as well as to identify associated factors.</div></div><div><h3>Methods</h3><div>This was a retrospective, single-center, cohort study. Current Procedural Terminology codes for laminectomy and microdiscectomy were used to identify patients from October 2012 to November 2024. Charts were reviewed to obtain additional demographic and clinical characteristics on which an initial univariate analysis was performed. Primary outcomes for this study included measurements of accuracy for predicting rehab discharge. Secondary outcomes included associations of variables with rehab discharge. Those with confounding diagnosis or admitted from a rehabilitation facility were excluded. Machine learning models were trained and evaluated on the data using cross-validation and classification metrics were utilized for model comparison.</div></div><div><h3>Results</h3><div>A total of 486 patients were considered for the analysis. After performing a Benjamini-Hochberg correction, the univariate analysis identified multiple statistically significant variables associated with rehabilitation discharge some of which include age, preoperative leg pain, lower extremity weakness, need for a walking assistive device, and frailty. Of the 5 machine learning models tested, the logistic regression model demonstrated superior performance, with the highest area under curve (0.81), Youden’s J statistic (0.55) and balanced accuracy (0.78). The logistic regression model demonstrated that age and the use of an ambulatory assistive device are consistently predictive of rehabilitation discharge (p&lt;.001).</div></div><div><h3>Conclusions</h3><div>When considered alongside frailty, lack of support, and other variables, age and the necessity for a walking assistive device can serve as a reliable predictors of rehabilitation discharge, thereby improving patient workflow, minimizing uncertainty and reducing healthcare costs.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100815"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient selection, clinical outcomes, associated healthcare utilization, and cost-effectiveness of basivertebral nerve ablation for the treatment of vertebrogenic low back pain: A narrative review1","authors":"Reza Ehsanian MD, PhD ,&nbsp;Jordan A. Buttner BS ,&nbsp;Byron Schneider MD ,&nbsp;Zachary L. McCormick MD","doi":"10.1016/j.xnsj.2025.100788","DOIUrl":"10.1016/j.xnsj.2025.100788","url":null,"abstract":"<div><h3>Background</h3><div>Chronic low back pain (cLBP) represents a significant burden to global health, with a prevalence projected to reach 843 million individuals by 2050. Vertebrogenic cLBP, a distinct phenotype, is mediated by nociception transmitted through the basivertebral nerve. Advances in basic and translational science have established clinical imaging biomarkers of vertebrogenic cLBP, such Type 1 and 2 Modic changes, to more reliably identify this condition. Additionally, medical technology advances have provided the ability to selectively disrupt pain signaling from painful vertebral endplates by interosseous basivertebral nerve ablation (BVNA). The objective of this review is to highlight appropriate patient selection, clinical outcomes, associated healthcare utilization, and cost-effectiveness of BVNA in the treatment of vertebrogenic cLBP.</div></div><div><h3>Methods</h3><div>PubMed, EMBASE, and Google Scholar databases were queried for articles published before September 2024. Two authors reviewed references for eligibility, extracted data, and appraised the quality of evidence.</div></div><div><h3>Results</h3><div>Patient selection criteria include the presence of Type 1 or Type 2 Modic changes on MRI in the context of clinical suspicion of anterior element spinal pain based on clinical evaluation. BVNA was found to result in clinically significant and sustained pain relief and functional improvements in individuals with vertebrogenic cLBP. Randomized controlled trials and systematic reviews demonstrate long-term efficacy, with clinically meaningful benefits sustained up to 5 years postprocedure. Healthcare utilization analyses indicate that BVNA significantly reduces low back pain-related healthcare utilization, opioid use, and surgical intervention rates. Economic analysis indicates that BVNA is cost-effective when compared to conventional management of vertebrogenic cLBP.</div></div><div><h3>Conclusions</h3><div>In appropriately selected patients, the overall body of evidence demonstrates that BVNA is an effective and durable treatment for vertebrogenic cLBP.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100788"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145325760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}