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BackTable / MSK / Podcast / Episode #13

Basivertebral Nerve Ablation

with Dr. Olivier Clerk-Lamalice

In this episode, Dr. Jacob Fleming interviews Dr. Olivier Clerk-Lamalice about basivertebral nerve ablation for vertebrogenic back pain, including indications, procedure technique and exciting tech on the horizon in minimally invasive spine interventions.

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Basivertebral Nerve Ablation with Dr. Olivier Clerk-Lamalice on the BackTable MSK Podcast)
Ep 13 Basivertebral Nerve Ablation with Dr. Olivier Clerk-Lamalice
00:00 / 01:04

BackTable, LLC (Producer). (2023, June 18). Ep. 13 – Basivertebral Nerve Ablation [Audio podcast]. Retrieved from

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Podcast Contributors

Dr. Olivier Clerk-Lamalice discusses Basivertebral Nerve Ablation on the BackTable 13 Podcast

Dr. Olivier Clerk-Lamalice

Dr. Olivier Clerk-Lamalice is an interventional radiologist that specializes in interventional pain management and diagnostic imaging in Calgary, Canada.

Dr. Jacob Fleming discusses Basivertebral Nerve Ablation on the BackTable 13 Podcast

Dr. Jacob Fleming

Dr. Jacob Fleming is a diagnostic radiology resident and future MSK interventional radiologist in Dallas, Texas.


Dr. Clerk-Lamalice trained in Canada, first in engineering, and then medicine and diagnostic radiology at the Université de Sherbrooke in Calgary. He then completed a neuroradiology fellowship at Harvard, and a fellowship in interventional pain at The Spine Fracture Institute in Oklahoma City with Dr. Douglas Beall. Furthermore, he obtained his credentials as a fellow of interventional pain practice (FIPP), which is a widely recognized international designation. He now works at a comprehensive outpatient radiology center, where he practices both diagnostic and interventional radiology daily. They offer intrathecal drug administration, spinal cord stimulators, vertebral augmentation, Spine Jack, disc augmentation, nucleolysis, and various nerve blocks and ablations in and out of the spine. Their goal was to create a one stop shop for patients to come for consultation, imaging, expert advice and treatment.

Next, we discuss vertebrogenic back pain and the basivertebral nerve (BVN). The BVN is a nonmyelinated, intraosseous nerve, while most other peripheral nerves are myelinated, meaning they can regenerate. The BVN cannot, so ablation of this nerve is a permanent treatment. It is located within the central portion of the vertebral body midway between the superior and inferior end plates, one third ventral to the posterior wall of the vertebral body. On a sagittal T2 sequence on MRI, there is a triangle at the posterior aspect at the midpoint of the vertebral body called the basivertebral canal, which contains the nerve, artery and vein. The BVN is responsible for vertebrogenic back pain, which is a form of anterior column pain characterized by low back pain worsened by flexion and sitting. It is diagnosed via MRI using the Modic classifications. Modic type 1 (edematous), and type 2 (fibrofatty end plate) changes can be seen in this disease. It can be difficult to distinguish vertebrogenic from discogenic pain due to the fact that the sinuvertebral nerve (SVN), responsible for discogenic pain, crosses paths with the BVN. However, with MRI and an anesthetic discogram, it is possible to determine the etiology and choose the right treatment.

Finally, we discuss the steps of the procedure. Dr. Clerk-Lamalice uses an 8 gauge needle via a transpedicular approach, as is common for other spine procedures. He ensures the probe is positioned in the center of the vertebral body, parallel to the endplates. The nerve is ablated for 15 minutes at 85 C. The procedure takes 45 minutes, which includes an epidural steroid injection to bridge pain control during the periprocedural period. Patients usually go home within one hour after the procedure, and begin to experience the results within a couple days. There have been two trials for BVN ablation, which have made this intervention the most minimally invasive and evidence-based treatment for vertebrogenic pain. These studies indicated 25% of patients had a 50% reduction in pain, while 75% of patients had a 75% reduction of pain. Within that 75%, 30% reported being almost entirely pain free. To date, the study has followed participants to 8 years, and the results show the treatment is durable.


Transcript Preview

[Dr. Olivier Clerk]
I understand it from a surgical perspective that you try to help those patients, but now I think we have very strong Level 1 data that demonstrate clearly that, hey, there's a better procedure that takes around a half an hour to 45 minutes and that provides very reliable pain decrease and improvement in function and the patient will feel the result of that procedure within a couple of hours after the intervention. Doing a fusion and doing even a disc replacement for those patients should no longer be a thing.

Disclaimer: The Materials available on are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

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Getting Started with Basivertebral Nerve Ablation (BVNA)

Basivertebral Nerve Ablation: A Physician's Guide

Basivertebral Nerve Ablation (BVNA) Procedure Technique: A Practical Guide

Basivertebral Nerve Ablation (BVNA) Procedure Technique: A Practical Guide


Back Pain Condition Overview
Basivertebral Nerve Ablation (BVNA) Procedure Prep
Chronic Pain Condition Overview
Discogenic Pain Condition Overview
Low Back Pain Condition Overview
Nerve Ablation Procedure Prep

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