What is vertebrogenic pain?
The lumbar disc sits between two vertebral bodies, sandwiched between the cartilage and bone of the vertebral endplate. When the endplate becomes inflamed — from chronic disc disease, micromotion, or degeneration — MRI shows characteristic signal changes called Modic type 1 (T1 hypointense, T2 hyperintense, edema-like) or Modic type 2 (fatty marrow change). The basivertebral nerve, which runs into the back of the vertebral body through a small channel called the basivertebral foramen, carries pain signals out of that inflamed bone.1
This is a different pain generator than disc herniation, facet arthropathy, or radiculopathy — and it requires a different treatment. Intracept targets it directly.
Why this matters
Vertebrogenic pain is estimated to account for a meaningful portion of chronic axial low back pain that doesn’t respond to conventional treatments. For these patients, repeated epidural injections, medial branch RFAs, and spine surgery often miss the actual source. Intracept addresses the right nerve.
Why an interventional radiologist — image-guidance is everything
Several specialties perform Intracept. The procedure is the same; what differs is the depth of training in image guidance, and that is where outcomes are made or lost. Intracept depends on placing a cannula through the pedicle — a small bony channel just centimeters from the spinal cord, exiting nerve roots, and the great vessels in front of the spine — and advancing it accurately into the back of the vertebral body. There is no margin for guesswork.
Interventional radiologists complete a dedicated one- to two-year fellowship in image-guided procedures, performed almost entirely under live fluoroscopy, CT, ultrasound, and angiography. By the time we finish training, we have done thousands of image-guided procedures — including transpedicular access for vertebroplasty, kyphoplasty, vertebral biopsy, and tumor ablation — using exactly the same approach Intracept requires.2
That depth of image-guidance training translates directly into:
- More accurate transpedicular access, with confident trajectories and real-time correction
- Lower risk of pedicle wall breach and the neurologic complications that follow it
- Faster procedures with less radiation, because experienced operators acquire the right images the first time
- Comfort with anatomic variants and difficult cases — small pedicles, sclerotic bone, prior surgery, scoliosis
How the procedure works
Intracept is performed in a hospital interventional suite under sedation. Under live fluoroscopic guidance, transpedicular access is made through the targeted vertebra. A specialized cannula is advanced through the pedicle to the basivertebral nerve, and a radiofrequency probe is used to ablate it. Two to three contiguous lumbar levels are typically treated in a single session. There are no implants left behind, no fusion, and no anatomic alteration of the spine.
Who is a good candidate?
You may be a candidate for Intracept if:
- You have chronic low back pain for at least 6 months that has not responded to physical therapy, medications, and at least one prior interventional treatment
- Your lumbar MRI shows Modic type 1 or type 2 endplate changes at the painful levels (typically L3 through S1)
- Your pain is axial (in the back) rather than radicular (radiating down the leg)
- You’re seeking an alternative to lumbar fusion or chronic opioid use
Candidacy is determined together with your pain management, spine surgery, neurosurgery, or physiatry team.
What the research shows
The SMART and INTRACEPT trials showed significant and durable improvements in pain and function compared with sham and standard care, with 5-year follow-up data confirming the benefit is maintained.3,4 Because the basivertebral nerve does not regenerate after ablation, the relief is long-lasting.
References
- Fields AJ, Liebenberg EC, Lotz JC. Innervation of pathologies in the lumbar vertebral end plate and intervertebral disc. Spine J. 2014;14(3):513–521.
- Society of Interventional Radiology / American Board of Radiology. Vascular and Interventional Radiology Subspecialty Certification — fellowship training requirements in image-guided procedures including transpedicular spine access (vertebroplasty, kyphoplasty, biopsy, ablation).
- Fischgrund JS, Rhyne A, Macadaeg K, et al. 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. Eur Spine J. 2020;29(8):1925–1934.
- Khalil JG, Smuck M, Koreckij T, et al. A prospective, randomized, multicenter study of intraosseous basivertebral nerve ablation for the treatment of chronic low back pain. Spine J. 2019;19(10):1620–1632.
Frequently asked questions
Why does it matter who performs Intracept?
Intracept depends on accurate transpedicular access — placing a cannula through a small bony channel into the back of the vertebral body without injuring the spinal cord, nerve roots, or the great vessels in front of the spine. That accuracy comes from extensive training in image guidance. Interventional radiologists complete a one- to two-year fellowship dedicated to image-guided procedures, where we perform thousands of fluoroscopy- and CT-guided spine procedures, including transpedicular access for vertebroplasty, kyphoplasty, biopsy, and tumor ablation. That depth of experience translates directly into safer, more accurate Intracept procedures.
What is vertebrogenic pain, and how is it different from disc pain?
Vertebrogenic pain comes from the vertebral endplate — the cap of cartilage and bone where the disc meets the vertebral body. When the endplate becomes inflamed, MRI shows Modic type 1 or type 2 changes, and the basivertebral nerve carries pain signals from the inflamed bone. This is a different pain generator than disc herniation, facet arthropathy, or nerve root compression.
Is Intracept FDA approved?
Yes. The Intracept system (Relievant Medsystems) is FDA-cleared for the treatment of chronic vertebrogenic low back pain in adults with Modic type 1 or type 2 endplate changes on MRI. It’s covered by Medicare and most major insurance plans when criteria are met.
How long does the relief last?
Pain relief from Intracept is durable. Published 5-year follow-up from the SMART trial showed that improvements in pain and function were maintained, and the basivertebral nerve does not regenerate after ablation. The procedure is not typically repeated.
Is Intracept the same as a regular spine RFA?
No. The radiofrequency ablation procedures most patients have heard of (lumbar medial branch RFA) target the small nerves to the facet joints. Intracept targets a completely different nerve — the basivertebral nerve, which lies inside the vertebral body and carries pain from the endplate. Different anatomy, different access, different patients.
Will I avoid spine surgery?
Intracept is offered as an alternative to lumbar fusion for patients whose pain is specifically from vertebrogenic disease. Whether you ultimately need surgery depends on the broader picture, including any structural problems Intracept doesn’t treat. Those decisions are made together with your spine surgeon or neurosurgeon.
Is the procedure painful?
The procedure is performed under sedation. Most patients describe pressure rather than pain. Mild back soreness at the access sites is common for several days afterward and is usually well-controlled with over-the-counter medication.
