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Understanding Basivertebral Nerve Ablation (Intracept) for Chronic Low Back Pain Chronic low back pain is one of the most common complaints among patients, affecting quality of life, mobility, and even mental well-being. While there are many causes of low back pain, one source that's often overlooked is vertebrogenic pain—pain originating from the vertebral endplates. Basivertebral nerve ablation, also known as the Intracept procedure, is an innovative, minimally invasive treatment specifically designed to target this type of pain at its source. What is Vertebrogenic Pain? Vertebrogenic pain occurs when the vertebral endplates—where the vertebrae connect to the spinal discs—become damaged or inflamed. This can lead to chronic pain that’s resistant to traditional therapies like physical therapy, medications, and even other types of spinal injections. For years, there weren't many effective treatments for vertebrogenic pain. But recent advancements in medical technology have led to the development of the Intracept procedure. What is the Intracept Procedure? The Intracept procedure is a minimally invasive treatment that targets the basivertebral nerve, which transmits pain signals from the vertebral endplates. By ablating, or "turning off," this nerve, the Intracept procedure disrupts the pain pathway, providing significant and lasting relief for many patients. How Does It Work? During the procedure, a specialized probe is inserted into the vertebra through a small incision. Using radiofrequency energy, the probe heats and ablates the basivertebral nerve, effectively "shutting down" the pain signal being sent from the damaged vertebra. The entire procedure typically takes about an hour and is performed on an outpatient basis, meaning most patients can go home the same day. Who is a Candidate? The Intracept procedure is intended for patients who: Have been experiencing chronic low back pain for more than six months. Have not found relief from conservative treatments like physical therapy, medications, or injections. Have MRI findings that indicate Modic changes, a marker of inflammation and degeneration in the vertebral endplates. Do not have significant disc or nerve compression that would otherwise explain their pain. Benefits of Basivertebral Nerve Ablation Long-Lasting Pain Relief : Many patients experience significant pain reduction that lasts years after the procedure . Minimally Invasive : This outpatient procedure requires only a small incision, leading to quicker recovery times compared to traditional back surgeries. Improved Quality of Life : By targeting the nerve responsible for vertebrogenic pain, the Intracept procedure can restore function and improve quality of life. What to Expect After the Procedure Recovery time varies, but most patients can return to normal activities within a few days. You may experience some soreness at the treatment site, but this typically resolves quickly. Patients often report gradual improvement in their pain levels over several weeks, with the best results seen at the 3- to 6-month mark. Is Intracept Right for You? If you’ve been dealing with chronic low back pain that hasn’t responded to other treatments, and if MRI findings suggest Modic changes in your vertebrae, the Intracept procedure may be worth considering. It’s important to consult with a specialist who can evaluate your unique situation and help determine if basivertebral nerve ablation is the right option for you. Final Thoughts At Spine & Nerve, we’re committed to providing innovative, evidence-based treatments to help our patients find relief and improve their quality of life. The Intracept procedure is a promising solution for those suffering from vertebrogenic pain, offering an option where traditional therapies may fall short. If you’re ready to explore whether basivertebral nerve ablation could be the answer to your chronic low back pain, reach out to our team to schedule a consultation. Together, we’ll work to find the best treatment plan to get you back to living your life, pain-free.

A sacroiliac joint (SI) injection is an image guided, minimally invasive method of targeted drug therapy which is performed to relieve low back/buttock pain. Steroid medication can reduce the swelling and inflammation caused by conditions such as arthritis or joint dysfunction. This minimizes side effects when compared to oral medications and increases efficacy. How is a sacroiliac joint injection performed? Patient Positioning The patient lies face down. Tissue Anesthetized A local anesthetic (typically lidocaine) is used to numb the skin and the tissues along the anticipated path of the needle. Fluoroscopic Guidance Using a fluoroscope for guidance (live x-ray guidance), the physician directs the needle toward the sacroiliac joint. A contrast solution is injected to assess for ideal location and safety. The physician uses the fluoroscope to confirm the correct location of the needle tip. Steroids Injected A steroid-anesthetics mix is injected into the sacroiliac joint, bathing the painful tissues with a potent anti-inflammatory medication. End of Procedure The needle is removed and a small bandage is applied to cover the tiny needle surface wound. How long does it take for the sacroiliac joint injection to work? Most people feel some benefit from the injection between 3-7 days however it can take up to two weeks before we see the full results. Who performs a sacroiliac joint injection? Sacroiliac joint injections are performed by one of the board certified interventionalists at Spine & Nerve Diagnostic Center (SNDC). Our interventionalists have performed thousands of these procedures. Where are sacroiliac joint injections performed? Sacroiliac joint injections are typically performed at our state of the art SNDC procedure suites.

Overview The rotator cuff of the shoulder is composed of four different muscles that support the shoulder joint. This group of muscles keeps the head of the humerus (upper arm bone) secured within the shallow socket of the shoulder joint. When the rotator cuff tendons are injured they become irritated or damaged, resulting in pain, weakness and reduced range of motion. Rotator cuff injuries are common and increase with age, in people who have jobs with overhead motions such as painters and carpenters. Many people can manage their symptoms and return to activities with physical therapy to improve strength and flexibility; however some patients also require surgical interventions to help correct the injury. Symptoms Rotator cuff injuries can manifest as pain, weakness, and/or range of motion. Pain in rotator cuff injuries can be described as a deep ache in the shoulder that can also disturb sleep. Rotator cuff injuries will make it difficult for the person to perform any over head motions such as brushing your hair, or reaching behind your back. Patients may also experience weakness when performing specific movements. Diagnosis Diagnosis of rotator cuff injuries is primarily through physical exam with your medical provider. X-rays, ultrasound, and MRI are also utilized to help diagnose the extent of rotator cuff injuries. Treatment Conservative treatments for rotator cuff injuries include rest, ice, and physical therapy. If these do not provide relief then cortisone or steroid injection can be helpful in reducing inflammation in the shoulder joint. As a last resort corrective surgery may be needed to repair the rotator cuff tendons, this is typically done arthroscopically.

Overview Knee osteoarthritis is a degenerative disease involving the cartilage in the knee joint. Osteoarthritis occurs when the protective cartilage surrounding the end of your bone begins to wear down. It can most commonly affect the knees, hips, hands, and spine. Symptoms can usually be managed, but the damage to the joints can never be reversed. Risk factors for developing osteoarthritis include age, gender, obesity, previous joint injuries, repetitive stress on a joint, genetics, bone deformities, and metabolic disorders. Symptoms Symptoms of osteoarthritis develop slowly over time and can vary from person to person. Most commonly, patients will experience joint pain, stiffness (especially in the morning), tenderness around the joint, loss of flexibility or range of motion, grinding sensation, and swelling. Diagnosis Diagnosis of osteoarthritis of a joint can be made by taking an x-ray of the joint to evaluate the bones in the knee joint. An MRI may also be useful in diagnosing osteoarthritis to help evaluate the soft tissue around the joint. Treatment Treatment of osteoarthritis first begins with lifestyle changes including consistent exercise and proper weight management. Physical therapy, and pool therapy have also been shown to be effective in helping treat osteoarthritis pain. Additionally, alternative movement therapies such as tai-chi and yoga have been found to help reduce pain caused by osteoarthritis. Traditional medication options include acetaminophen (Tylenol), and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, or Aleve. Supplements such as glucosamine/chondroitin, capsaicin, and omega-3 fatty acids, while controversial in efficacy, have anecdotally reduced patient’s osteoarthritis pain. Devices such as knee braces and a TENS unit can also provide relief. Typically, if lifestyle changes, therapies, and medications fail to relieve pain, then cortisone or steroid injections can be performed to help reduce inflammation in the knee joint. Other available injections include hyaluronic acid, prolo injection therapy, and platelet-rich-plasma injections. Finally, if all conservative measures fail, the patient can undergo surgery to change the structure of the knee. Two types of surgeries are available: partial knee replacement and total knee replacement.

This is a disease of the spine indicating degenerative changes, sometimes referred to as arthritis of the spine. It can happen at any level (cervical, thoracic or lumbar) and results in different types of pain including mechanical and radicular pain. CAUSES Primarily this is caused by aging and normal wear and tear. With time, the components of the spine, including the vertebrae, the discs between the vertebrae, and the joints of the spine rub against one another, causing pain. SYMPTOMS Cervical Spine: neck, shoulder and arm pain. Radicular symptoms may occur including numbness, weakness in the arms or legs. Thoracic Spine: upper chest and abdomen pain, and may cause numbness, tingling and weakness in the legs Lumbar Spine: lower back, buttocks, and leg pain; and may cause numbness, tingling and weakness in the lower leg. This is often times worsened with sitting, twisting, lifting and bending. TREATMENT This varies based on severity of degeneration, and symptoms patients describe. It includes anti- inflammatory medications, physical therapy, water therapy, back braces, spinal injections and in severe cases, surgery.

Facet joints are found on the back of the entire spine (cervical, thoracic and lumbar). Each vertebrae rests on top of one another at these facet joints. These joints may become inflamed or irritated, causing pain. A steroid injection into the joint may be used to help alleviate pain and diagnose the source of a patient’s pain. Q&A 1. How is a facet joint injection performed? a. Patient positioning: face down on a procedure table. 2. Will the procedure be painful? a. A local anesthetic is used to numb the skin. This feels similar to a bee sting and lasts for a very short time, usually less than 30 seconds. 3. How does the physician know where to inject? a. The physician uses fluoroscopic guidance (live XR imaging) directing the needle into the facet joint space. A contrast solution is injected and confirms the location of the medication to be placed. 4. What is injected? a. A mixture of anesthetic (numbing medicine) and steroid (anti-inflammatory) is injected into the joint space. 5. End of Procedure a. The needle is removed and a small bandage is placed to cover the site of the injection. 6. How long will it take to work? a. Relief usually takes 3-7 days to estimate relief. 7. Who performs a facet joint injection? a. Facet joint injections are performed by one of the board certified interventionalists at Spine and Nerve Diagnostic Center (SNDC). Our interventionalists have performed thousands of these procedures. 8. Where are facet joint injections performed? a. Facet joint injections are performed at our state of the art SNDC procedure suites.

Overview Hip osteoarthritis is a degenerative disease involving the cartilage in the hip joint. Osteoarthritis occurs when the protective cartilage surrounding the end of your bone begins to wear down over time. It can most commonly affect the knees, hips, hands, and spine. Symptoms can usually be managed but the damage to the joints can never be reversed. Risk factors for developing osteoarthritis include age, gender, obesity, previous joint injuries, repetitive stress on a joint, genetics, bone deformities, and metabolic disorders. Symptoms Symptoms of osteoarthritis develop slowly over time and can vary from person to person. Most commonly, patients will experience joint pain, stiffness (especially in the morning), tenderness around the joint, loss of flexibility or range of motion, grating sensation, and swelling. Diagnosis Diagnosis of osteoarthritis of a joint can be made with x-ray of the joint. MRI may also be useful in diagnosing osteoarthritis. Treatment Treatment of osteoarthritis first begins with lifestyle changes including consistent exercise and proper weight management. Physical therapy and pool therapy have also been shown to be effective in helping treat osteoarthritis pain. Additionally, alternative movement therapies such as tai-chi and yoga have been found to help reduce pain caused by osteoarthritis. Traditional medication options include acetaminophen (tylenol), and non-steroidal anti- inflammatory drugs (NSAIDs) such as ibuprofen, or aleve. Supplements such as glucosamine/chondroitin, capsaicin, and omega-3 fatty acids, while controversial in efficacy, have anecdotally reduced patient’s osteoarthritis pain. Typically, if lifestyle changes, therapies, and medications fail to relieve pain, then cortisone or steroid injections can be performed to help reduce inflammation in the hip joint. Finally, if all conservative measures fail the patient can undergo surgery to replace the hip joint. This is typically done by an orthopedic surgeon.

Piriformis syndrome occurs when the piriformis muscle, which is located deep in the buttock, causes pain. The piriformis muscle starts at the lower spine and attaches to the upper thigh bone. It functions to rotate the hip outward. What causes Piriformis Syndrome? Swelling, inflammation and spasm can occur in the piriformis muscle due to trauma, prolonged sitting or repetitive injury such as from sports. The pain may run down the back of the thigh. How is Piriformis Sydrome diagnosed? There is no direct, definitive test for Piriformis Syndrome. It is diagnosed by history and physical exam. Imaging may be ordered to rule out other pathologies. How is Piriformis Syndrome treated? Avoiding the activities that trigger the pain is important. Rest, ice, and heat can be helpful. Physical therapy, stretching, and exercises can also help relieve pain. Anti-inflammatories and muscle relaxers can ease pain. Injections with a steroid or botox can reduce the inflammation, pain, and spasm. 

What is medial epicondylitis? Medial Epicondylitis also know as Golfer’s elbow is the inflammation of the tendons that connect the muscles of the muscles of the forearm to the elbow. The pain is felt at the medial epicondyle (the bony bump on the inner side of the elbow). Causes of medial epicondylitis It is caused by repetitive motions, overuse of the arm, and stress on the fore arms which leads to small tears at the flexor tendons triggering pain, weakness, stiffness. Risk Factors: This condition is common among athletes such as golfers and people who play racquet sports. It also is common in persons involved in professions requiring repetitive motions such as carpenters, painters, and computer users. Symptoms of medial epicondylitis There is pain, tenderness, and stiffness at the medial epicondyle that can radiate to the fore arm and wrist. Numbness and tingling in the fingers Weakness of the hand and wrists Difficulty moving the left elbow Treatment Options Rest and avoid activities that require repetitive movement until the pain disappears. Acupuncture therapy, massage therapy and use of an electronic pulse massager can relieve the pain and improve circulation. Ice and a cold compress can help to reduce swelling and inflammation. Physical therapy/Occupational therapy: stretching helps stretch and strengthen the tendons. OTC pain killers and anti- inflammatories can help reduce the pain and inflammation. Topical ointments such as the lidopro ointment to reduced localized pain and inflammation. Steroid injections and PRP injections helps to reduce swelling, inflammation, and can initiate or expedite the healing process. Wrist splint/Brace: can provide additional support and pain relief to reduce muscle strain. Laser therapy that we offer in clinic.