Could Your Chronic Low Back Pain Be Vertebrogenic?

Chronic low back pain can have many causes, from muscle strain and arthritis to herniated discs and spinal stenosis. But for some people, persistent pain may come from a specific structure within the spine: the vertebral endplates.

This type of pain is known as vertebrogenic low back pain. Unlike some forms of back pain that originate in muscles, joints, or compressed spinal nerves, vertebrogenic pain is associated with damage or changes involving the vertebral endplates and the basivertebral nerves that transmit pain signals from inside the vertebral bodies.

Understanding the signs of vertebrogenic pain can help patients recognize when a different approach to diagnosis and treatment may be appropriate.

What Is Vertebrogenic Low Back Pain?

Vertebrogenic low back pain is chronic pain that originates from the vertebral endplates, which are located where the spinal discs meet the vertebral bones.

The endplates can become damaged or inflamed as part of degenerative changes in the spine. When this happens, signals can travel through the basivertebral nerves, which carry sensory information from inside the vertebral bodies.

Vertebrogenic pain is therefore different from pain caused primarily by irritated spinal nerve roots. A person can have significant low back pain without experiencing the classic shooting leg pain associated with sciatica.

What Causes Vertebrogenic Pain?

Degenerative changes in the spine are a common factor in vertebrogenic pain. Over time, repeated stress and wear can affect the spinal discs and vertebral endplates.

When the endplates become damaged, inflammatory processes may develop within the vertebral bodies. These changes can contribute to chronic pain.

MRI scans may show characteristic changes known as Modic changes, particularly Modic type 1 or type 2 changes. These findings can help physicians determine whether vertebral endplate changes may be contributing to a patient’s symptoms.

However, an MRI finding alone does not automatically mean that a person’s pain is vertebrogenic. Diagnosis typically involves considering imaging findings alongside the patient’s symptoms, medical history, and physical examination.

What Does Vertebrogenic Back Pain Feel Like?

Vertebrogenic back pain is often described as a deep, aching pain in the lower back. The pain may become worse with certain movements or activities, including sitting, bending, lifting, or prolonged physical activity.

Unlike some nerve-related conditions, vertebrogenic pain does not necessarily travel down the leg.

• Persistent or recurring low back pain
• Deep aching or burning sensations in the lower back
• Pain that worsens with sitting or bending
• Pain associated with physical activity
• Limited tolerance for prolonged sitting or standing
• Pain that persists despite conservative treatment

Because these symptoms can overlap with other causes of chronic low back pain, a proper evaluation is important.

How Is Vertebrogenic Low Back Pain Diagnosed?

Diagnosing vertebrogenic pain generally requires more than identifying chronic low back pain.

A physician may review the patient’s symptoms, perform a physical examination, and evaluate imaging studies such as an MRI. Particular attention may be given to changes in the vertebral endplates and the presence of Modic changes.

The physician may also consider other potential causes of pain, including facet joint problems, spinal stenosis, disc herniation, sacroiliac joint dysfunction, and other spinal conditions.

The goal is to determine whether the vertebral endplates and basivertebral nerves are likely to be the primary source of pain.

Is Vertebrogenic Pain the Same as Sciatica?

No. Vertebrogenic pain and sciatica involve different pain mechanisms.

Sciatica generally occurs when a spinal nerve root becomes irritated or compressed, often because of a herniated disc or spinal stenosis. It can cause pain, numbness, tingling, or weakness that travels from the lower back into the buttock and leg.

Vertebrogenic pain originates from the vertebral endplates and typically presents as axial low back pain rather than pain that follows a nerve pathway into the leg.

A person can have both conditions, but they are not the same diagnosis.

What Treatments Are Available for Vertebrogenic Low Back Pain?

Treatment depends on the underlying cause, severity, duration, and overall health of the patient.

Initial treatment may include conservative approaches such as physical therapy, activity modification, and other nonsurgical strategies. However, some patients continue to experience significant pain despite conservative care.

For appropriately selected patients with confirmed vertebrogenic pain, basivertebral nerve ablation may be an option.

This minimally invasive procedure, commonly known as the Intracept procedure, uses radiofrequency energy to target the basivertebral nerves inside the vertebral body. The goal is to interrupt the transmission of pain signals from the affected vertebral endplates.

Not every patient with chronic low back pain is a candidate for this treatment. Careful patient selection and diagnostic evaluation are essential.

Who May Be a Candidate for Basivertebral Nerve Ablation?

Basivertebral nerve ablation may be considered for certain adults with chronic low back pain that has not adequately improved with conservative treatment.

Candidates typically undergo a comprehensive evaluation to determine whether their symptoms and imaging findings are consistent with vertebrogenic pain.

MRI evidence of specific endplate changes can be an important part of the evaluation, but treatment decisions should be based on the complete clinical picture.

Can Vertebrogenic Pain Be Prevented?

Not every case of vertebrogenic pain can be prevented because spinal degeneration is influenced by factors such as age, genetics, previous injury, and cumulative stress on the spine.

Maintaining regular physical activity, developing core and back strength, using proper lifting mechanics, maintaining a healthy body weight, and addressing persistent back symptoms early may support overall spinal health.

Most importantly, chronic low back pain should not simply be accepted as an unavoidable part of aging. Persistent symptoms deserve an appropriate evaluation to identify the potential source of pain.

When Should You See a Specialist for Chronic Low Back Pain?

Persistent low back pain that interferes with work, exercise, sleep, or daily activities may warrant evaluation by a spine or pain specialist.

A specialist can assess the possible sources of pain and determine whether diagnostic imaging or other testing is appropriate. For patients whose symptoms suggest vertebrogenic pain, identifying endplate changes and determining whether the basivertebral nerves may be involved can help guide treatment decisions.

Vertebrogenic low back pain is a distinct potential source of chronic spinal pain, and recognizing it may open the door to treatment options that differ from those used for other types of back pain.

This article is intended for educational purposes only and should not be considered medical advice. A qualified healthcare professional should evaluate persistent or severe back pain and determine the appropriate diagnosis and treatment.