Durable pain relief following basivertebral nerve ablation in patients with prior lumbar decompression: A retrospective case series.

BACKGROUND: Basivertebral nerve (BVN) ablation has emerged as a safe and effective treatment for vertebrogenic low back pain. However, patients with prior lumbar surgery were excluded from prior clinical trials, and BVN ablation outcomes in this patient population remain poorly characterized. OBJECTIVE: To evaluate clinical outcomes following BVN ablation in patients with a history of lumbar decompression surgery. METHODS: This retrospective case series included 14 adult patients who underwent BVN ablation at our institution from November 2019 to January 2025. Patients were included if they had a history of prior lumbar decompressive surgery with at least one overlapping vertebral level between the surgical site and subsequent BVN ablation levels. Pain severity was assessed using the Visual Analog Scale (VAS) at baseline, 4-6 weeks, 6 months, and 12 months post-procedure. RESULTS: Mean (±SD) VAS decreased from 7.07 ± 2.24 at baseline to 4.43 ± 2.21 at 4-6 weeks, 3.71 ± 1.94 at 6 months, and 3.21 ± 1.89 at 12 months. The mean decrease in VAS from baseline was 3.86 ± 2.51 at 12 months. 12 patients (85.7%; 95% CI: 57.2%-98.2%) achieved a ≥ 2-point VAS decrease from baseline at 12 months, and 13 patients (92.9%; 95% CI: 66.1%-99.8%) reported functional improvement at 12 months. No vertebral compression fractures were observed during a mean (±SD) follow-up period of 3.29 ± 1.10 years. CONCLUSIONS: In this 14-patient retrospective case series, BVN ablation was associated with sustained and clinically meaningful pain reduction in patients with prior lumbar decompression surgery. Our findings suggest that evaluation for a vertebrogenic pain component should be considered in patients with persistent pain after lumbar decompression, as appropriately selected patients may still benefit from BVN ablation.