INTRACEPT PROCEDURE

What is an Intracept Procedure?

The Intracept Procedure refers to a minimally invasive procedure that targets the basivertebral nerve for the relief of chronic low back pain. This procedure does not require any implantation or change of the spinal structure. Several clinical studies show the effectiveness of this Intracept procedure that includes immediate relief of the patient’s back pain and long-lasting relief. Lower back pain affects almost 30% of the total U.S. population, which leads to almost 52 million neurosurgeon visits per year. Among the affected patients with low back pain, almost 15% develop chronic back pain that lasts over 12 weeks (Smuck et al., 2021).

One of the common causes of lower back pain includes pain transmission from the basivertebral nerve. Basivertebral nerves include a group of nerves, commonly found within the bones of the spine, called vertebrae. Branches of these basivertebral nerves extend to both the lower and upper vertebral surfaces. Aging and degeneration put additional stress over the vertebrae and lead to damage which causes chronic low back pain. Intracept acts as the only procedure specifically approved to stop pain transmitted through the basivertebral nerve. This nerve helps to transmit vertebrogenic pain (originating within the vertebrae).

Conditions for an Intracept Procedure

Basic indication for Intracept procedure includes patients with chronic low back pain without spinal fractures, instability or scoliosis. Physicians also find some degenerative changes over the vertebrae by several tests such as MRI or X-ray. Over time, the vertebral endplates damage and produce smaller fissures that allow spinal disc material to enter the vertebra itself, causing inflammation. Patients eligible for the Intercept procedure should experience chronic lower back pain for almost 6 months and should not respond to any nonsurgical conservative treatments.

Benefits and Risks of an Intracept Procedure

The Intracept procedure works to reduce chronic low pain with the combination of radiofrequency (RF) generators for the ablation of basivertebral nerves of the L3 through S1 vertebrae. The neurosurgeon may find some chronic Modic changes (type 1 or 2) such as inflammation, edema, disruption and fissuring of the endplate, vertebral surface changes, hypotensive signals, fibrous tissue deposition within the bone marrow, and replacement of bone marrow by fat, etc. with the help of MRI. The benefits of the Intracept procedure may include (Tieppo Francio et al., 2021):

  •     Helps patients who have experienced persistent lower back pain for over 6 months
  •     Minimally invasive, outpatient procedure
  •     No implantation which preserves the actual spinal structure
  •     Provides immediate relief from chronic low back pain

Contraindications for Intracept procedure include pregnancy, weak pulmonary and cardiac function, the previous implantation of pacemaker or defibrillator, having a systemic infection, etc. The risk of this procedure includes some sort of local infection and delayed healing.

How does a Spinal Surgeon perform an Intracept Procedure?

Intracept procedure differs from other surgical options like spinal fusion, total disc replacement, and spinal cord stimulation by its minimally invasive nature and factors such as having no implants. This procedure also requires a lower average recovery time than the other surgical options. The entire process of an Intracept procedure may include (Fischgrund et al., 2020):

  •     Neurosurgeon cleaning the surgical area with antiseptics before the Intracept procedure
  •     The neurosurgeon will make a small incision (5-6 mm) into the surgical site to insert a small metal straw to the vertebral body 
  •     Under fluoroscopic guidance, the neurosurgeon will introduce a cannula through the pedicle of vertebrae
  •     This Intracept curved cannula helps to create a channel on the basivertebral nerve trunk
  •     Later, the neurosurgeon will insert a radiofrequency probe into the curved path and place it at the basivertebral nerve.
  •     This radiofrequency generator will help to ablate the basivertebral nerve (disable the nerve)

This whole operation time varies according to the number of treated vertebrae and the condition of the patient. The average time of an Intracept procedure may last about 1 hour and 20 minutes. Most patients can go home on the same day of operation. Nearly 80% of patients showed an interest in undergoing Intracept procedures again for the same condition and almost 65% of patients give positive feedback 5 years after the operation (Urits et al., 2021).

What Does Recovery from an Intracept Procedure Look Like?

Several studies show the safety and effectiveness of this Intracept procedure. Results from one study showed the improvement of the condition of patients (53% pain improvement) over a 24 months period after the operation (Khalil et al., 2019). Neurosurgeons determine the recovery time of the patient based on their activities. Most patients can resume their normal activities within 1 or 2 weeks of an Intracept procedure. Neurosurgeons suggest seeing physical therapists before going home. Usually, physical therapists suggest the patient avoid heavy lifting for a couple of months. Neurosurgeons instruct patients to avoid weight lifting and twisting the back to avoid any strain injuries until 4-6 weeks. Please contact us for any further information.

References

Fischgrund, J. S., Rhyne, A., Macadaeg, K., Moore, G., Kamrava, E., Yeung, C., … Sikorsky, M. (2020). Long-term outcomes following intraosseous basivertebral nerve ablation for the treatment of chronic low back pain: 5-year treatment arm results from a prospective randomized double-blind sham-controlled multi-center study. European Spine Journal, 29(8), 1925–1934. https://doi.org/10.1007/s00586-020-06448-x

Khalil, J. G., Smuck, M., Koreckij, T., Keel, J., Beall, D., Goodman, B., … Garfin, S. (2019). A prospective, randomized, multicenter study of intraosseous basivertebral nerve ablation for the treatment of chronic low back pain. Spine Journal, 19(10), 1620–1632. https://doi.org/10.1016/j.spinee.2019.05.598

Smuck, M., Khalil, J., Barrette, K., Hirsch, J. A., Kreiner, S., Koreckij, T., … Investigators, I. T. (2021). Prospective , randomized , multicenter study of intraosseous basivertebral nerve ablation for the treatment of chronic low back pain : 12- ­ month results. 683–693. https://doi.org/10.1136/rapm-2020-102259

Tieppo Francio, V., Sherwood, D., Twohey, E., Barndt, B., Pagan-Rosado, R., Eubanks, J., & Sayed, D. (2021). Developments in Minimally Invasive Surgical Options for Vertebral Pain: Basivertebral Nerve Ablation – A Narrative Review. Journal of Pain Research, Volume 14, 1887–1907. https://doi.org/10.2147/jpr.s287275

Urits, I., Noor, N., Johal, A. S., Leider, J., Brinkman, J., Fackler, N., … Viswanath, O. (2021). Basivertebral Nerve Ablation for the Treatment of Vertebrogenic Pain. Pain and Therapy, 10(1), 39–53. https://doi.org/10.1007/s40122-020-00211-2