Vertebral Body Pain

Vertebral body pain can significantly impact quality of life, limiting mobility and causing chronic discomfort. Understanding the anatomy of the vertebral body, the common causes of pain originating from this area, and the available diagnostic and interventional treatment options is crucial for effective management and relief.

Basic Anatomy of the Vertebral Body

The vertebral body is a large, cylindrical part of the vertebra that bears most of the load in the spine. Each vertebra consists of the vertebral body at the front and the vertebral arch at the back, which together encase the spinal cord. The vertebral body is composed of a spongy cancellous bone surrounded by a harder cortical bone, providing a balance of strength and flexibility. Intervertebral discs sit between vertebral bodies, acting as cushions to absorb shock and allow movement.

Causes of Vertebral Body Pain

Additional medical insights into vertebral fractures are available through the National Institutes of Health (NIH).

Pain originating from the vertebral body can stem from various sources, including:

1. Osteoporosis and Compression Fractures: Osteoporosis weakens the bone, making it more susceptible to fractures, which can cause severe pain.
2. Degenerative Disc Disease: As intervertebral discs degenerate, the vertebral bodies can become misaligned, leading to pain.
3. Tumors and Metastases: Primary tumors or metastases from cancers such as breast, prostate, or lung cancer can invade vertebral bodies, causing pain.
4. Infections: Conditions like vertebral osteomyelitis can lead to severe, persistent pain.
5. Trauma: Acute injuries, such as those from accidents, can fracture or displace vertebral bodies, resulting in immediate and intense pain.
6. Vertebrogenic Pain: Vertebrogenic pain is a more specific clinical diagnosis that refers to chronic low back pain originating from endplate damage and inflammation, mediated by the basivertebral nerve (BVN). This deserves more explanation, as it frequently confuses our patients and their families.

Vertebrogenic Pain vs. Vertebral Body-Related Pain

Although they may sound similar, vertebrogenic pain and vertebral body-related pain are not the same. Understanding their differences is essential for accurate diagnosis and treatment planning.

🔹 Vertebral Body-Related Pain

This term refers to any pain that originates from the vertebral body, the thick, load-bearing part of the spine. It encompasses a wide range of causes including:

• Osteoporotic compression fractures
• Tumors or metastatic lesions
• Infections such as vertebral osteomyelitis
• Traumatic injuries
• Degenerative structural changes

It is a broad anatomical descriptor and can involve mechanical, nociceptive, or inflammatory pain sources within the vertebral body.

🔹 Vertebrogenic Pain

Vertebrogenic pain is a more specific clinical diagnosis that refers to chronic low back pain originating from endplate damage and inflammation, mediated by the basivertebral nerve (BVN).

Key features include:

• Presence of Modic type 1 or 2 changes on MRI
• Inflammation at the vertebral endplates
• Not caused by disc herniation, facet joints, or sacroiliac joints

This condition is often treated with the Intracept Procedure, which involves radiofrequency ablation of the BVN.

✅ Summary

Diagnosis and Work-Up

A thorough work-up is essential to identify the precise cause of vertebral body pain. The diagnostic process typically includes:

1. Clinical Evaluation: A detailed medical history and physical examination help identify pain patterns and potential underlying causes.
2. Imaging Studies: X-rays, MRI, and CT scans are crucial for visualizing bone integrity, disc health, and potential tumors or infections.
3. Bone Density Tests: These are particularly useful in diagnosing osteoporosis-related issues.
4. Laboratory Tests: Blood tests can help identify infections, inflammatory markers, or cancer indicators.

Interventional Treatment Modalities

For a detailed scholarly discussion of treatments, refer to this PubMed clinical article.

When conservative treatments such as medication, physical therapy, or bracing fail to provide adequate relief, interventional treatments can be considered. These modalities focus on directly addressing the source of pain within the vertebral body:

• Vertebroplasty and Kyphoplasty: These minimally invasive procedures involve injecting bone cement into the fractured vertebra. Kyphoplasty includes an additional step of balloon inflation to restore vertebral height.
• Radiofrequency Ablation (RFA): This technique uses heat generated by radiofrequency energy to target and destroy nerve fibers carrying pain signals. RFA can be particularly effective for tumors or metastatic lesions in the vertebrae.
• Intracept Procedure: This technique is similar to radiofrequency ablation. A small drill is used to reach the basivertebral nerve in the middle of the vertebral body and heat signals are used to destroy them. This treatment has shown remarkable extended relief and is now being promoted as an alternative to spinal fusion surgery.
• Spinal Injections:
  • Facet Joint Injections: Though typically for facet-related pain, these injections can sometimes alleviate pain stemming from the vertebral body due to the close anatomical relationship.
  • Epidural Steroid Injections: Administering steroids into the epidural space can reduce inflammation and pain originating from degenerative changes affecting the vertebral bodies.
• Advanced Image-Guided Interventions: Techniques like MRI-guided focused ultrasound (MRgFUS) offer non-invasive pain relief by targeting specific areas within the vertebral body with precise ultrasound waves.
• Tumor Ablation Techniques: For patients with vertebral body tumors, procedures such as cryoablation (using extreme cold to destroy tissue) or microwave ablation (using electromagnetic waves) can effectively reduce pain and control tumor growth.

Conclusion

Vertebral body pain can arise from a variety of causes, each requiring a tailored approach for diagnosis and treatment. While traditional therapies may suffice for some, interventional treatments offer promising solutions for those with persistent or severe pain. By leveraging advanced imaging and minimally invasive techniques, healthcare providers can significantly enhance pain management and improve patient outcomes. For those suffering from vertebral body pain, a comprehensive and personalized treatment plan is essential to restore function and quality of life.

References

1. Jensen ME, McGraw JK, Schultz TM, Kallmes DF. “Vertebroplasty in the treatment of osteoporotic compression fractures: clinical outcomes in 1000 patients.” Radiology. 2003.
2. Levine SA, Perin LA, Hayes D, Hayes WS. “An evidence-based evaluation of percutaneous vertebroplasty.” Managed Care Interface. 2000.
3. Barr JD, Barr MS, Lemley TJ, McCann RM. “Percutaneous vertebroplasty for pain relief and spinal stabilization.” Spine. 2000.
4. Ploeg WT, Veldhuizen AG, Smit TH. “Percutaneous vertebroplasty as a treatment for osteoporotic vertebral compression fractures: a systematic review.” Eur Spine J. 2006.
5. Kallmes DF, Comstock BA, Heagerty PJ, et al. “A randomized trial of vertebroplasty for osteoporotic spinal fractures.” N Engl J Med. 2009.

These references provide a deeper dive into the techniques and efficacy of various interventional treatments for vertebral body pain.