Computed Tomographic Characterization for Basivertebral Nerve Ablation Utilizing a Radiofrequency Multitined Expandable Electrode

Abstract

Dawood Sayed,1 Douglas P Beall,2 Amitabh Gulati,3 Eric Hyman,4 Jon E Block5 1KU Medical Center, Kansas City, KS, USA; 2Comprehensive Specialty Care, Edmond, OK, USA; 3Memorial Sloane Kettering, New York, NY, USA; 4HaA, Inc., Wakefield, MA, USA; 5Private Practice, San Francisco, CA, USACorrespondence: Jon E Block, Email [email protected]: A growing body of clinical evidence has demonstrated that intraosseous minimally invasive basivertebral nerve (BVN) ablation results in significant and durable improvements in vertebrogenic back pain. Thus, it is important to develop, refine and validate new and additional devices to accomplish this procedure.Methods: Using reconstructions of 31 patient computed tomography (CT) scans of the lumbosacral spine (L1-S1), the primary objective was to simulate the intravertebral placement of a novel multitined expandable electrode in bipolar configuration at the targeted ablation site and determine if the proper trajectories could be achieved in order for the device tips to be in the correct position for lesion formation at the BVN plexus. Successful device deployment required that the distance between tips was between 10 mm and 20 mm.Results: The mean distances between device tips ranged from 11.35 mm (L5) to 11.87 mm (L3), and there were no statistically significance differences across the six vertebral levels (F = 0.72, p = 0.61). The percentage of successful intraosseous device placements within the tip distance acceptable range (≥ 10 mm to ≤ 20 mm) was 90% (162 of 180), with no tip-to-tip distances > 20 mm. There was a notable association between decreasing vertebral level and mean degree of angulation between contralateral devices ranging from 50.90° at L1 to 91.51° at S1, and the difference between across the six vertebral levels was significant (F = 89.5, p < 0.01).Conclusion: Feasibility evidence is provided from real world CT imaging data that validates using the multitined electrode for proper intraosseous placement within the vertebral body to effectively ablate the BVN plexus.Keywords: vertebrogenic pain, basivertebral nerve, endplate, radiofrequency ablation, Subsidio, electrode, back pain

Keywords

• vertebrogenic pain
• basivertebral nerve
• endplate
• radiofrequency ablation
• subsidio
• electrode
• back pain