Author - G. Sunny Sharma, M.D.
Back pain is one of the most common reasons people see a doctor or miss days at work. The number of people globally with low-back pain increased from 377.5 million in 1990 to 577 million in 2017.
One of those people is television host Carson Daly, who recently detailed his decades-long struggle with lower back pain in a story on the Today show. Daly also shared his experience undergoing a breakthrough, minimally invasive procedure called Intracept.
Designed to provide long-term relief of chronic low-back pain that originates inside the vertebrae, Intracept is the only procedure approved by the U.S. Food & Drug Administration (FDA) for this condition. As a minimally invasive outpatient procedure, Intracept targets and deadens the nerves responsible for vertebrogenic low-back pain with radiofrequency heat – without a lengthy recovery or spinal implants.
Ankit Patel, M.D.
My colleague, Ankit Patel, M.D., and I are two of a small pool of physicians in the Metroplex who offer the Intracept procedure, and more of our colleagues in the UT Southwestern Spine Center are starting to use the technology.
In clinical studies, patients reported continued pain relief and functional improvement for longer than six years after treatment. A previous study was closed early because Intracept showed significantly superior pain relief compared to standard low-back pain treatment. According to data published in Orthopedic Design & Technology, 64% of patients reported more than 50% pain relief, and 30% reported complete pain relief within 12 months after the procedure.
We are excited to be able to offer this innovative treatment and help patients enjoy more pain-free days.
Pinpointing the source of low-back pain
Approximately 80% of people will experience low-back pain at some point in their lives, and 20% of those people develop chronic low-back pain, meaning it lasts 12 weeks or longer.
How we treat back pain depends on its cause. It was long thought that low-back pain was largely due to trouble in the discs, the cushions that separate each of the spine’s bones (vertebrae) from each other.
Some low-back pain originates inside the vertebrae, not the spinal discs.
Today we know that low-back pain can also originate inside the vertebrae – specifically from the nerves in the vertebral endplates, where the bone meets the discs. Just like other parts of the body, the vertebral endplates are vulnerable to deterioration and nerve damage. Nerves carry the messages between your body and brain that help you feel sensations, including pain.
This is known as vertebrogenic low-back pain, and it was designated as an official diagnosis with an International Classification of Diseases (ICD) code in October 2021.
While anti-inflammatory medications, physical therapy, or cortisone injections can help some patients, conservative treatments are not always effective for vertebrogenic low-back pain. Fortunately, we now have this new, highly effective procedure to offer our patients.
How Intracept relieves chronic low-back pain
Intracept targets the major nerve that runs through the vertebrae, known as the basivertebral nerve. Using radiofrequency energy, Intracept applies heat through a small probe to deaden or eliminate the problematic nerve.
Once ablated, the nerve will no longer transmit a pain signal.
Patients receive anesthesia and a local anesthetic to numb the skin. Your physician will use real-time fluoroscopic X-ray guidance to access the painful vertebrae with a small introducer needle.
The minimally invasive Intracept procedure allows our spine specialists to reach vertebral nerves and disrupt pain signals. (Photo credit: Relievant Medsystems)
A curved instrument is passed through the introducer needle to create a channel through the vertebral bone to the base of the basivertebral nerve. A specialized probe is then run through the channel and placed directly next to the nerve. The probe generates heat, which burns the nerve and disrupts pain signals before they can branch out and reach the brain.
The instruments will then be removed, and a small bandage will be applied over the entry points. The Intracept procedure takes about an hour, and you will be monitored while the sedation wears off. You can go home later that day, but you will need someone to drive you.
Most patients report significant pain relief within two to four weeks. Most patients can resume normal activities after a brief recovery period, though we may recommend avoiding specific movements or strenuous activity such as weightlifting for a few days.
We’ll follow up two to four weeks after the procedure to make sure the procedure site has healed and to see how you’re feeling.
Intracept provides long-term pain relief after a single procedure and will not reduce your ability to move normally. Many surgeries for back pain involve implants, such as screws or plates, but because Intracept uses radiofrequency ablation, no devices are left in the body. Having Intracept also will not preclude you from having a future spine procedure.
Who may qualify for Intracept
While this is a fairly new procedure, Medicare and many insurance plans cover it. Candidates for Intracept must meet three criteria:
- Chronic low-back pain for at least six months.
- Conservative treatments such as physical therapy, medication, or injections have not sufficiently reduced pain.
- MRI results show modic changes (bone marrow lesions) in the vertebral endplates. This means there is swelling and inflammation that is irritating a nerve in the vertebra.
Even then, it may take some extra work to persuade your insurer. At the end of his story, Mr. Daly mentions he had a four-month appeal process, but he said the time and effort were well worth it.
Many patients come to us after first seeing their primary care physician for low-back pain. If conservative treatments don’t provide sufficient relief, ask your doctor for a referral to a spine specialist or make an appointment for yourself with our PM&R or spine experts.
Our primary goal is to get you back to your daily life with more pain-free days and improved function. We work closely with specialists in neurosurgery, orthopedic surgery, anesthesiology and other fields – no matter your condition, we can connect you with the best care in one place.
Your spine is your core. Everything is connected to it. When your back hurts, everything you do is impacted. But you don’t have to live with pain. We’ll work with you to find the best treatment for your condition, from medication and physical therapy to innovative treatments such as Intracept.
To find out whether you might benefit from Intracept, call 214-645-2225 or request an appointment online.