Introduction
The Intracept Procedure, also known as Basivertebral Nerve Ablation, is a minimally invasive treatment designed to alleviate chronic lower back pain. This innovative approach targets the basivertebral nerve (BVN), which is responsible for transmitting pain signals from the vertebral endplates to the brain. By ablating this nerve, the procedure aims to provide significant and long-lasting pain relief for patients suffering from vertebrogenic pain.
Understanding Vertebrogenic Pain
Vertebrogenic pain originates from the vertebral bodies and is often associated with Modic changes, which are degenerative changes in the vertebral endplates and adjacent bone marrow. These changes can be detected through MRI scans and are classified into three types:
- Modic Type 1: Represents inflammatory changes and is typically associated with acute pain and edema.
- Modic Type 2: Indicates fatty degeneration of the bone marrow, linked to chronic pain.
- Modic Type 3: Displays sclerotic bone changes and is often associated with advanced degeneration.
Patients with chronic lower back pain and Modic Type 1 or 2 changes are considered ideal candidates for the Intracept Procedure.
Intracept: A Minimally Invasive Solution
Intracept stands out amongst other treatments due to its minimally invasive nature. The procedure utilizes radiofrequency energy to target and deaden the nerves responsible for vertebrogenic low-back pain, without the need for major surgery. This outpatient procedure effectively disrupts pain signals, offering a compelling alternative to invasive spine surgery.
Remarkably, the efficacy of the Intracept Procedure in alleviating vertebrogenic pain ranges from 64-74%. This success rate, combined with its minimally invasive nature, makes Intracept a preferred choice among patients suffering from chronic low back pain, seeking lasting relief with minimal recovery time. It should not affect the function of the spinal cord transmitting sensations to and from other parts of the body.
The Intracept Procedure: Step-by-Step
The Intracept Procedure involves several key steps:
1. Patient Selection
Proper patient selection is crucial for the success of the Intracept Procedure. Candidates typically include those who have experienced chronic lower back pain for at least six months, have not responded to conservative treatments, and exhibit Modic Type 1 or 2 changes on MRI scans.
2. Preparation and Anesthesia
The procedure is performed in a sterile environment, typically under local anesthesia with sedation. This approach minimizes discomfort while allowing the patient to remain conscious and responsive during the procedure.
3. Accessing the Basivertebral Nerve
Using fluoroscopic guidance, the physician inserts a specialized introducer needle into the vertebral body. Through this needle, a radiofrequency ablation probe is advanced to the precise location of the basivertebral nerve at the junction of the vertebral endplates.
4. Ablation of the Basivertebral Nerve
Once the probe is correctly positioned, radiofrequency energy is delivered to ablate the basivertebral nerve. This process typically takes about 15 minutes per vertebra. The ablation disrupts the nerve’s ability to transmit pain signals, leading to pain relief.
5. Post-Procedure Care
After the procedure, patients are monitored for a short period before being discharged. Most patients can resume normal activities within a few days, although they are advised to avoid strenuous activities for a couple of weeks.
Benefits of the Intracept Procedure
The Intracept Procedure offers several advantages over traditional treatments for chronic lower back pain:
- Minimally Invasive: The procedure is performed through small incisions, reducing the risk of complications and promoting faster recovery.
- Long-Lasting Pain Relief: By targeting the source of vertebrogenic pain, the procedure provides sustained relief for many patients.
- Quick Recovery: Most patients can return to their daily activities shortly after the procedure, with minimal downtime.
- Reduced Dependence on Medications: Successful outcomes can lead to a significant reduction in the need for pain medications.
Risks and Considerations
As with any medical procedure, the Intracept Procedure carries certain risks, including:
- Infection: Although rare, there is a risk of infection at the insertion site.
- Nerve Damage: Accidental damage to surrounding nerves or tissues, though uncommon, is a potential risk.
- Incomplete Pain Relief: While many patients experience significant relief, some may not achieve the desired level of pain reduction.
It is essential for patients to discuss these risks with their healthcare provider and weigh them against the potential benefits.
Clinical Evidence and Research
Numerous studies have demonstrated the efficacy and safety of the Intracept Procedure. Clinical trials have shown significant improvements in pain scores and functional outcomes for patients undergoing the procedure. Long-term follow-up studies indicate that the benefits of the procedure can last for several years, making it a viable option for chronic lower back pain management.
Nursing Care of Patient with Intracept Procedure (Basivertebral Nerve Ablation)
Pre-procedure Care
Patient Education
- Provide detailed information about the Intracept Procedure, including its purpose, benefits, and potential risks.
- Explain the steps of the procedure to alleviate patient anxiety and promote understanding.
- Discuss pre-procedure instructions, such as fasting requirements and medication adjustments.
Pre-procedure Assessments
- Conduct a thorough medical history review, focusing on allergies, current medications, and previous surgical experiences.
- Perform a physical examination to assess the patient’s general health status.
- Ensure all required pre-operative tests and imaging studies are completed and reviewed by the healthcare team.
Post-procedure Care
Monitoring and Assessment
- Regularly monitor vital signs, including blood pressure, heart rate, respiratory rate, and temperature.
- Assess the insertion site for signs of infection, such as redness, swelling, and discharge.
- Evaluate pain levels using a standardized pain scale and document any changes in pain intensity.
Pain Management
- Administer prescribed pain medications as needed and monitor for effectiveness and side effects.
- Encourage the use of non-pharmacological pain relief methods, such as ice packs, relaxation techniques, and positioning.
Activity and Mobility
- Encourage gradual resumption of daily activities, emphasizing the importance of avoiding strenuous activities and heavy lifting.
- Provide guidance on proper body mechanics and ergonomic principles to prevent further injury.
Patient Education and Discharge Planning
- Educate the patient on signs and symptoms of potential complications that require prompt medical attention, such as severe pain, fever, or signs of infection.
- Discuss the importance of follow-up appointments to monitor progress and address any concerns.
- Provide written instructions on post-procedure care, including wound care, activity restrictions, and medication management.
Long-term Care and Follow-up
Regular Follow-up Visits
- Schedule regular follow-up appointments to assess pain levels, functional status, and overall recovery progress.
- Monitor for any late-onset complications and address them promptly.
Rehabilitation and Physical Therapy
- Refer the patient to physical therapy for tailored exercises to improve strength, flexibility, and functional mobility.
- Encourage adherence to the physical therapy regimen to enhance recovery and prevent recurrence of pain.
Patient Support and Counselling
- Offer emotional support and reassurance to the patient throughout the recovery process.
- Provide resources for psychological counselling if needed, to address any anxiety or depression related to chronic pain.
By following these guidelines, nursing professionals can ensure comprehensive care and support for patients undergoing the Intracept Procedure, promoting optimal recovery and long-term pain relief.
REFERENCES
- Eshraghi Y, Shah JD, Guirguis M. Novel Technologies in Interventional Pain Management (https://pubmed.ncbi.nlm.nih.gov/35526983/). Phys Med Rehabil Clin N Am. 2022 May;33(2):533-552.
- Nwosu M, Agyeman WY, Bisht A, et al. The Effectiveness of Intraosseous Basivertebral Nerve Ablation in the Treatment of Nonradiating Vertebrogenic Pain: A Systematic Review (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10075185/). Cureus. 2023 Apr 4;15(4):e37114.
- John Smirniotopoulos, How the Intracept Outpatient Procedure Relieves Nerve-Related Lower Back Pain.July 22, 2022, https://www.medstarhealth.org/blog/intracept-lower-back-pain
- Schnapp W, Martiatu K, Delcroix GJ. Basivertebral nerve ablation for the treatment of chronic low back pain in a community practice setting: 6 Months follow-up. https://pubmed.ncbi.nlm.nih.gov/36926532/. N Am Spine Soc J. 2023 Jan 29;14:100201.
- Tieppo Francio V, Sayed D. Basivertebral Nerve Ablation https://www.ncbi.nlm.nih.gov/books/NBK572127/). 2023 May 22. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan.
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