WHY DO I HAVE LOW BACK PAIN?
The causes of low back pain are broad, but generally can be broken down to muscles/connective tissue, joints, or nerves. The most likely cause of low back pain that doesn’t extend into the legs is either from muscles/connective tissue or joints. Muscles/connective tissue pain is usually related to an acute injury, or from chronic changes that cause relative deconditioning of the low back muscles that stem from things like obesity, lack of exercise/use, or changes to the curvature of the spine. The joints in the low back that can cause pain are the facet joints, sacroiliac joints, or the vertebral body which forms a “joint” with the bone below at the intervertebral disc. The first two joints are more common pain generators, but the vertebral body/disc can cause pain when certain changes occur in the spine; these are called “modic changes”, and when these are seen in people with low back pain, they are likely contributing to the pain to some degree.
MY MRI SAYS I HAVE MODIC CHANGES, WHAT DOES THAT MEAN?
Modic changes occur when there are changes to the bone because of damage or inflammation at the area. They are usually associated with significant loss of the disc at the level which can occur as your spine ages. The modic changes occur in three flavors, type 1, type 2, or type 3. Type 1 occurs when there is new inflammation of the bone with high bone turnover, type 2 is from long term inflammation when the bone marrow is replaced with fat, and type 3 occurs when the damage has been occurring for a long time and the bone is no longer trying to heal itself.
WHAT IS THE INTRACEPT PROCEDURE FOR PATIENTS WITH MODIC CHANGES?
Intracept is a one-time procedure that uses radiofrequency ablation to destroy the basivertebral nerve; this nerve is responsible for transmitting pain from the vertebral body and both its endplates. Unlike radiofrequency ablation for facet joints, these nerves do not have a protective covering, so a radiofrequency ablation will permanently destroy the nerves. The procedure is done with either anesthesia or sedation depending on the patient and number of levels being treated. Each radiofrequency ablation is 15 minutes long, so the minimum procedure length is 35 minutes. This is an outpatient procedure, and the patient will go home once they have recovered from sedation or anesthesia. The ablation works right away to treat pain from the vertebral body, but it often can take a few days to a couple weeks for the patient to recover from the procedure and realize the pain relief.
