Basivertebral Nerve Ablation

A good candidate has chronic low back pain from the vertebral endplates. Medicare in New York requires at least 6 months of pain that limits function, at least 6 months of non-surgical care that has not helped enough, and Modic type 1 or 2 changes on MRI in one or more vertebrae from L3 to S1^[1]. The pain is usually in the center of the lower back and worse with sitting or bending forward, rather than shooting down the leg^[8].

You are not a good candidate if your main problem is sciatica or leg symptoms from spinal stenosis, or if you have osteoporosis, a compression fracture, spinal cancer or an infection at the level to be treated. Medicare also excludes pregnancy, bleeding disorders, severe heart or lung disease, prior fusion at that level, a body mass index over 40 and active untreated substance use^[1]. A large herniated disc or slipped vertebra that explains your pain is usually addressed first.

You may be fully asleep or deeply relaxed, depending on the anesthesia plan. Medicare’s policy describes the procedure as performed with moderate (conscious) sedation or general anesthesia^[1]. With moderate sedation you are drowsy and may remember little afterward, and the skin is numbed. Most people feel pressure rather than sharp pain, and the procedure usually takes about an hour.

Bring your MRI, a list of all medicines and supplements, and your insurance information to your consultation. Your physician will review any blood thinners using interventional pain guidelines and coordinate with the doctor who prescribed them — never stop one on your own^[10]. On the day itself, follow the fasting instructions and bring an adult who can drive you home.

In well-selected patients, most people report meaningful improvement. In the INTRACEPT trial, 64% of treated patients had at least 50% less pain at 12 months and 29% were pain-free^[5]. A 2022 review rated the evidence as moderate quality^[6]. Results vary: in the sham-controlled SMART trial, the placebo group also improved substantially, and the gap between groups at 3 months was modest^[2].

For people who respond, relief has lasted for years in follow-up studies. In the SMART trial’s long-term report, 100 of 117 treated patients were reviewed at an average of 6.4 years; 66% reported more than 50% pain reduction and 34% reported complete relief^[3]. These long-term results did not include a comparison group, so they are encouraging but less certain than the 3-month randomized results.

Most people go home the same day and return to light activities within a few days. Soreness at the needle sites and a temporary increase in back pain are common at first. Some people develop temporary leg pain from nerve-root irritation; in the INTRACEPT trial this resolved in a median of 43 days^[5]. Your physician will advise when to resume exercise and lifting.

The main downsides are that it helps only one specific type of back pain, and some people do not improve. Temporary leg pain is the most commonly reported side effect, usually from irritation of a nerve near the pedicle^[6]. Infection and serious bleeding are rare. The research supporting it was funded by the device’s manufacturer^[6], and Medicare covers each vertebra only once in a lifetime^[1].

Medicare in New York covers it for patients who meet specific criteria. National Government Services — Medicare’s contractor for New York, renamed Wellpoint Federal in 2026 — has a coverage policy (LCD L40302) in effect for services from July 15, 2026^[1]. Commercial plans vary: some still consider the procedure investigational, which is a common reason for denials, and most require prior authorization. Workers’ compensation and no-fault claims follow their own approval rules. Our staff verifies your benefits before scheduling.

Each vertebra is generally treated only once. Medicare in New York covers ablation once per vertebral body from L3 to S1 per lifetime, with up to four vertebral bodies treated in one procedure^[1]. If pain later develops at a different level that meets the criteria, that level may be considered. If pain persists after a technically successful treatment, your physician will look for other sources rather than repeating the same level.

Alternatives depend on where your pain comes from. Active physical therapy and a home exercise program remain the foundation for most chronic low back pain. If the facet joints are suspected, medial branch blocks and radiofrequency ablation may help; for leg pain from a pinched nerve, an epidural steroid injection is often considered. For persistent pain after other treatments, spinal cord stimulation or a surgical opinion may be options.

It is performed in our office or at an affiliated ambulatory surgery center, depending on your anesthesia needs and insurance. Consultations take place at our practice on East 23rd Street in Gramercy / Kips Bay, Manhattan. You go home the same day, but you will need an adult to accompany you because of the sedation. Contact us to schedule an evaluation.