Vertebrogenic back pain, or vertebral endplate pain, is caused by damage to the endplates of your vertebrae. Your endplates contact the rubbery disk between each pair of vertebrae.

The idea that damage to your endplates may play a significant role in chronic lower back pain has gained significant popularity among researchers in recent years. It’s now known that there are a significant number of pain receptors in your endplates connected to a nerve inside your vertebra called the basivertebral nerve.

As of now, the most consistent and specific treatment for vertebrogenic pain is a procedure called basivertebral nerve ablation. This minimally invasive procedure involves using a laser to stop the basivertebral nerve from sending pain signals to your brain.

Read on to learn more about vertebrogenic back pain, including its symptoms, how it’s diagnosed, and how it’s managed.

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Illustration of vertebrogenic pain caused by damage to vertebral end plates. | Medical Illustration by Bailey Mariner.

Vertebrogenic pain tends to appear as lower back pain along the midline of your spine.

Pain often worsens with:

  • bending forward
  • sitting for prolonged periods
  • physical activity

Pain is usually described as:

  • deep
  • aching
  • burning

Some people have referred pain (pain that’s felt elsewhere in the body) in the area around their spine or glutes.

Some people have pure vertebrogenic pain, while others also have pain related to a degenerated disk. A degenerative disk is the breakdown of a disk from chronic wear and tear.

If a degenerated disk in your lower spine puts pressure on your spinal cord, it may also cause symptoms in your lower body like:

  • numbness
  • tingling
  • weakness

Vertebrogenic pain is caused by damage to the endplates of your vertebrae. Your endplates are the parts of your vertebrae that contact your disks. They play an important role in dispersing forces from your disks to prevent injury. Arteries in your endplate also provide nutrients to your disks.

Researchers in the late 1990s discovered that the bony tissue in the body of your vertebrae is filled with blood vessels and pain receptors connected to the basivertebral nerve. It’s now known that damage to your endplates can lead to the stimulation of these pain receptors.

Chronic lower back pain is very common, but a specific cause is only identifiable in about 20% of cases.

Vertebrogenic back pain may make up a significant portion of pain previously assumed to be caused by disk degeneration.

Factors linked to the development of degenerative disks include:

  • older age
  • increased height
  • obesity
  • heavy physical work
  • smoking
  • family history

A doctor will start by considering your personal and family medical history and performing a physical exam. A physical exam may involve having you move in certain ways, such as bending forward to see if these motions cause pain.

The doctor will likely send you for imaging tests if they think you may have a problem with your spinal column.

The primary way that doctors diagnose vertebrogenic pain is with magnetic resonance imaging (MRI). An MRI can identify changes around your endplates that might be stimulating pain receptors and contributing to your pain.

Two characteristic features called Modic type 1 and 2 changes are usually seen with an MRI:

  • Modic type 1: Bone marrow swelling and inflammation
  • Modic type 2: Red bone marrow replaced with yellow fatty bone marrow

There is emerging evidence that another type of imaging called single photon emission computed tomography (SPECT) scans might also be able to identify changes to your spine characteristic of vertebrogenic pain.

As with most causes of chronic back pain, doctors usually recommended trying conservative treatment before surgery. Conservative treatment options include:

If your pain doesn’t improve after trying conservative treatment options for at least 6 months, your doctor may recommend basivertebral nerve ablation. This minimally invasive procedure involves using a laser to heat your basivertebral nerve to keep it from transmitting pain signals to your brain.

Basivertebral nerve ablation procedure

Here’s a general idea of what you can expect during basivertebral nerve ablation.

  1. You’ll receive general anesthesia or a sedative through an IV and be positioned face down.
  2. Your surgeon will mark the treatment area, which will be confirmed with C-arm fluoroscopy or a CT scan.
  3. They’ll make a small incision in your skin to insert a thin tube called a cannula into the body of your vertebra.
  4. A radiofrequency probe will be inserted into the cannula and used to heat your nerve.
  5. Afterward, your skin will be closed and covered with a dressing. You can usually go home on the same day as your procedure.

Chronic back pain is a common problem. It’s a good idea to contact your doctor if your back pain persists for more than a few weeks.

It’s also important to visit your doctor if:

  • you have neurological symptoms, such as tingling, numbness, or weakness in your lower limbs
  • your pain isn’t responding to your current treatment
  • your pain is getting worse over time
  • you have a fever
  • you experience sudden weight loss
  • you experience loss of bladder or bowel control that is worse at night
  • you are not able to stand or walk

Verebrogenic pain has traditionally been attributed to degenerative disk disease. Taking steps to avoid disk degeneration may also help you reduce your chances of developing vertebrogenic pain. Ways you may be able to prevent disk degeneration include:

  • maintaining a moderate weight
  • avoiding smoking if you smoke (this can be difficult, but a doctor can help build a cessation plan that works for you)
  • stretching often when sitting for prolonged periods
  • getting regular physical activity

Vertebrogenic back pain is caused by damage to the endplates of your vertebra. It usually causes lower back pain that gets worse with prolonged sitting, physical activity, and bending forward.

The most consistent and specific treatment for vertebrogenic back pain is basivertebral nerve ablation. This is a minimally invasive procedure where a nerve inside a vertebra is heated with a laser to block the transmission of pain signals.