J Minim Invasive Spine Surg Tech.  2025 Apr;10(1):100-111. 10.21182/jmisst.2024.01921.

Endoscopic Spine Surgery Treatment of Lower Back Pain: Pathophysiology and Radiofrequency Treatment of Sinuvertebral and Basivertebral Neuropathic Spine Pain

• Wu PH
• Kavishwar RA
• Kim HS

• KMID: 2567503
• DOI: http://doi.org/10.21182/jmisst.2024.01921

Abstract

Chronic low back pain (CLBP) is a common health problem and a major cause of patient disability worldwide. The number of people with low back pain (LBP) and their years lived with disability are increasing despite technological advances. There remains a definitive gap between the evidence for effective management of CLBP and current practices. Degenerative disc disease is a major contributor to chronic back pain and also leads to activity limitation and work absence. CLBP is a complex, multidimensional condition yet to be fully understood. In many patients with LBP, magnetic resonance imaging scans show no obvious neural compression. Sensitized nociceptors within the posterior annulus have long been identified as a source of discogenic pain. However, the recent literature also supports the nociceptive capacity of the basiverterbal nerve, which carries vertebrogenic pain from the endplates. In degenerative disc disease, there is pathological neurotization of the sinuvertebral and basivertebral nerves due to stimulation of inflammatory pathways resulting from endplate damage. Radiofrequency ablation of the sinuvertebral nerve and basivertebral nerve provides effective and well-sustained pain relief to patients with LBP. The popularity of endoscopic spine surgery is increasing because of its magnified and clear visualization due to constant water irrigation. The objective of this manuscript is to provide a comprehensive review of discogenic pain, vertebrogenic pain, pathoanatomy, pathophysiology, and the pain generation pathways involved in degenerative disc disease and the role of endoscopic radiofrequency ablation in sinuvertebral and basivertebral neuropathy.

Keyword

Low back pain; Backache; Endoscopic spine surgery; Spine; Procedures; Pain procedure