Objective: This study presents an early multicentre experience with an adapted basivertebral nerve ablation (BVNA) technique using bilateral transpedicular access, evaluating its safety, efficacy, and potential for expanded indications. Methods: Participants were recruited from 2 Gold Coast centres based on the presence of chronic, sharp midline axial lower back pain and evidence of type 1 or type 2 Modic changes on imaging. The radiofrequency ablation procedure was performed via transpedicular access under computed tomographic guidance. Satisfaction outcomes were assessed at 2 months using a visual analogue scale and Likert scales. Statistical analyses compared outcomes according to sex and pain indications. Results: Forty patients were included in the study, of whom 33 underwent BVNA for Modic type 1 and type 2 vertebrogenic pain, and 8 underwent the procedure for expanded indications, with no complications reported. Among those treated for expanded indications, 2 had vertebrogenic endplate changes adjacent to a prior fusion, 2 had persistent pain following subacute osteoporotic fractures, and one each presented with a haemangioma, inflammatory endplate osteitis associated with spondyloarthropathy, and a postmyeloma fracture. Overall, 75% of participants reported being satisfied or very satisfied with the treatment of their painful condition. All patients treated for expanded indications expressed satisfaction or high satisfaction, with visual analogue score reductions ranging from 30% to 100%. Conclusion Early experience with BVNA using a bilateral transpedicular access technique suggests that it is a safe and effective procedure. It may also be applicable in selected cases involving expanded indications, particularly where persistent back pain remains refractory to or unsuitable for other therapeutic options.

Lumbar degenerative disc disease is extremely common. Current evidence supports surgery in carefully selected patients who have failed non-operative treatment and do not exhibit any substantial psychosocial overlay. Fusion surgery employing the correct grafting and stabilization techniques has long-term results demonstrating successful clinical outcomes. However, the best approach for fusion remains debatable. There is some evidence supporting the more complex, technically demanding and higher risk interbody fusion techniques for the younger, active patients or patients with a higher risk of non-union. Lumbar disc arthroplasty and hybrid techniques are still relatively novel procedures despite promising short-term and mid-term outcomes. Long-term studies demonstrating superiority over fusion are required before these techniques may be recommended to replace fusion as the gold standard. Novel stem cell approaches combined with tissue engineering therapies continue to be developed in expectation of improving clinical outcomes. Results with appropriate follow-up are not yet available to indicate if such techniques are safe, cost-effective and reliable in the long-term.
Arthroplasty ; Follow-Up Studies ; Humans ; Intervertebral Disc Degeneration ; Low Back Pain ; Stem Cells ; Tissue Engineering ; Transplants