Does BVNA Increase Fractures? Implications for Modic Change Epidemic

[drusso]

Assessment and management of patients developing low energy vertebral compression fractures following basivertebral nerve ablation

Guy Fogel, MD, Jacob Musie, BS, Tyler R Phillips, MD, Matthew Shonnard, MD, MPH, Salma Youssef, MS, Joshua A Hirsch, MD, Douglas P Beall, MD
Pain Medicine, Volume 25, Issue 3, March 2024, Pages 249–251, Assessment and management of patients developing low energy vertebral compression fractures following basivertebral nerve ablation
Published: 26 September 2023 Article history

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[Taus]

These patients had a mean T score of -3.0…..

 

[Ducttape]

and?


it is a retrospective observational study. 12% rate.

however, without control, one can only postulate that there is an increased risk - by looking at other data, which is a limitation.



does suggest that more study indicated and one should consider baseline bone density prior to BVNA...

 

[RoloTomassi]

I've done more than that paper with 0%. Pretty sure @Taus has a 0% fx rate. I don't know anyone who has done a significant n who has had fx. I think it speaks more to the author's technique. Additionally, half the fx were at off-label L2 and one was a sacral insufficiency where S1 was not even treated, so likely unrelated.

 

[lobelsteve]

So you are saying osteoporosis causes Fx.
Wow, shocker.

In any case, do the BVNA and send them to me for the kypho please.

 

[MitchLevi]

L2, sacral, adjacent level to fusion, adjacent level to kypho.

What exactly does this paper prove?

 

[clubdeac]

L2, sacral, adjacent level to fusion, adjacent level to kypho.

What exactly does this paper prove?

It proves that you can get almost any crap study peer reviewed and published

 

[Ducttape]

it shows that not all the ins and outs of BVNA have been completely elucidated, and more study needs to be done.




it also suggests that bones of the elderly are fragile and one might want to consider whether it is advisable to stick a metal rod in them.

 

[SSdoc33]

i think the point of the article is to suggest that its probably not a good idea to do DVNA on older, frail, osteoporotic patients with scoliosis.

the data dont suggest his yet, however. this was a hypothesis -- which may eventually turn out to be true -- that was looking for data

 

[Orin]

CMS and most insurer guidelines clearly state they should have a T-score greater than -2.5 where you're putting the needle/trocar.

Still, this isn't the BVNA's fault. It's the bone. If you're doing it on older, frailer folks with prior fragility fractures, treat the bone first and the BVN later if needed.

 

[Ducttape]

well, that needs to be elucidated.

if these patients did not have VCF without BVNA, then the BVNA was at least indirectly contributing to the fracture.

and you can technically say that it is the bones fault for the modic changes too.

thats why more studies need to be done.



or just dont do BVNA in patients with T score <-2.5.