The Intracept Procedure Treats Chronic Vertebrogenic Axial Low Back Pain
The Intracept procedure specifically treats chronic vertebrogenic axial low back pain associated with degenerative vertebral endplates, not radicular pain or other types of spine pain. 1
Understanding Vertebrogenic Pain and the Intracept Procedure
The Intracept procedure involves radiofrequency ablation of the basivertebral nerve (BVN) within vertebral bodies to treat a specific type of chronic low back pain. Here's what you need to know:
Mechanism and Target Pain Type
- Targets the basivertebral nerve that innervates the vertebral endplates
- Specifically treats vertebrogenic pain - axial back pain originating from pathologically degenerated vertebral endplates 1, 2
- Does NOT treat radicular pain (nerve root pain), facet joint pain, or discogenic pain without endplate involvement
Patient Selection Criteria
- Chronic axial low back pain (≥6 months duration)
- Pain unresponsive to at least 3 months of conservative care
- MRI evidence of Modic type I or II changes (indicating vertebral endplate degeneration)
- Positive confirmatory discography to determine affected levels 1
Evidence for Efficacy and Limitations
Efficacy Data
- Studies show significant improvement in:
- Oswestry Disability Index (ODI) scores
- Visual Analogue Scale (VAS) pain scores
- Physical function measures 1
- Improvements persist throughout 12-month follow-up periods
Important Limitations
- Very specific patient population eligible for this intervention
- Limited high-level or long-term studies
- Most research is industry-funded, raising potential bias concerns 2
- Cost-effectiveness analyses show favorable results compared to standard care, with an incremental cost-effectiveness ratio of $11,376 per QALY 3
Contrast with Other Interventional Procedures
The 2025 BMJ clinical practice guideline on interventional procedures for chronic spine pain makes strong recommendations against many common interventional procedures for chronic spine pain, including:
- Joint radiofrequency ablation (with or without injections)
- Epidural injections of local anesthetic, steroids, or combinations
- Joint-targeted injections
- Intramuscular injections 4
These recommendations are based on moderate certainty evidence showing these procedures have little to no effect on pain relief compared to sham procedures.
Clinical Application and Cautions
When to Consider Intracept
- For patients with confirmed vertebrogenic pain (not radicular pain)
- After failure of conservative management
- When MRI shows appropriate Modic changes
- When other interventional procedures are contraindicated or ineffective
Staged Approach Consideration
- In patients with both axial low back pain and associated neuropathic lower extremity pain, a staged approach using basivertebral nerve ablation in conjunction with traditional decompressive surgery may be beneficial 5
Important Cautions
- The Intracept procedure should not be used for treating neuropathic pain, for which evidence-based alternatives like anticonvulsants, antidepressants, and topical agents are recommended 6
- The procedure is not appropriate for pain associated with cancer, infection, or inflammatory spondyloarthritis 4
The Intracept procedure represents a targeted approach for a specific subset of chronic low back pain patients with vertebrogenic pain, but should not be considered for other types of spine pain where evidence does not support its use.