Rates of lumbar vertebral body compression fracture after basivertebral nerve ablation: A retrospective study utilizing a large national database.

BACKGROUND

Basivertebral nerve ablation (BVNA) is an effective treatment for vertebrogenic chronic low back pain. However, data regarding rates of post-BVNA lumbar vertebral compression fracture (VCF), particularly among patients with osteoporosis or osteopenia, remains limited.

OBJECTIVE

(1) Estimate the rate of lumbar VCF after BVNA. (2) Compare rates between patients with and without a pre-BVNA diagnosis of osteopenia/osteoporosis utilizing a large global database.

METHODS

A retrospective cohort study was performed using TriNetX, a national database of de-identified health records from over 130 million patients. Adults (≥18 years) who underwent BVNA between January 2022 and August 2025 were identified via CPT code. Patients were stratified by presence or absence of ICD-10 code for osteoporosis/osteopenia before undergoing BVNA. The primary outcome was incidence of ICD-10 code diagnosis of lumbar VCF after undergoing BVNA.

RESULTS

A total of 2387 patients underwent BVNA (mean age 63.7 years; 48.0 % female). Of these, 669 had a pre-BVNA diagnosis of osteoporosis/osteopenia (mean age 70.2 ± 10.7 years; 64.4 % female). Lumbar VCF occurred in 37 patients (1.55 %; 95 % CI, 1.11-2.16 %) after BVNA. Patients with osteoporosis/osteopenia had higher rate of post-BVNA lumbar VCF compared to those without (4.64 % vs 0.37 %), though rates of post-BVNA lumbar VCF were overall low across all patients (1.55 %). Osteoporosis/osteopenia was independently associated with post-BVNA VCF (adjusted OR 6.5; 95 % CI, 3.7-12.3; p < 0.001).

CONCLUSION

While patients with pre-BVNA ICD-10 code diagnosis of osteoporosis/osteopenia had higher rates and were at higher risk of post-BVNA VCF than those without, overall rates were still low. Risk of VCF should be considered and risks/benefits should be discussed with patients, but a diagnosis of osteoporosis/osteopenia should not be considered an absolute contraindication to BVNA.