Diagnosis: back pain
treatment: Thermal Destruction of Intraosseous Basivertebral Nerve, Including All Imaging Guidance.
The insurer denied Thermal Destruction of Intraosseous Basivertebral Nerve, Including All Imaging Guidance.
The health plan's determination is upheld.

The patient is a female with low back pain. The pain began several years ago. The pain is rated 7 out of 10 and impacts activities of daily living (ADL). Prior Treatments have included epidural injections, chiropractic care, massage, as well as medication management. Magnetic resonance imaging (MRI) lumbar spine showed Modic disc space L3-4 and L4-5 changes.

The proposed intraosseous basivertebral nerve ablation is not likely to be more beneficial than any standard treatment or treatments for the insured's life threatening or disabling condition or disease.
The patient has complaints of low back pain. This procedure is not recommended. Despite promising early reports, further trials with longer-term outcomes and less risk of bias are required. An Food and Drug Administration (FDA) investigational device exemption trial examined 225 chronic low back pain patients with type I or II Modic changes who were randomized to the requested procedure or sham treatment, resulting in decreased Oswestry disability index (ODI) of 20.5 and 15.2 points, respectively. The authors noted that these marginally clinically meaningful improvements suggested some potential as a minimally invasive treatment, however, there is lack of data to recommend this procedure as treatment modality. In general, there is lack of substantial support for this procedure, and it is currently not considered standard of care.