Vertebrogenic Low Back Pain

What is vertebrogenic low back pain?

Vertebrogenic low back pain happens when the vertebral endplates in your spine become damaged. Your endplates are protective layers between your vertebral bones and the disks that cushion them.

Vertebrogenic pain is distinct from other types of chronic low back pain. While injuries or arthritis cause other types of back pain, damaged endplates are the culprit of vertebrogenic pain.

In the past, healthcare providers attributed most cases of chronic low back pain to degenerative disk disease or arthritis. However, researchers later discovered nerves inside your vertebrae that can cause pain when they’re compressed. This new information shed light on other potential causes of back pain, suggesting that degenerative disk disease or arthritis may not always be to blame.

How common is vertebrogenic low back pain?

Over 30 million people in the United States have some type of chronic low back pain. But it’s hard to say how many of those cases are due to vertebrogenic pain. In fact, healthcare providers can only find a direct cause for chronic low back pain in about 20% of cases. Healthcare providers describe the other 80% as non-specific.

What are the symptoms of vertebrogenic low back pain?

People with vertebrogenic pain often describe it as a deep, burning or aching pain in the middle of their lower back. Some may develop referred pain (when you feel pain in another area instead of where it originated).

Pain often gets worse when you:

• Sit for prolonged periods of time.
• Are physically active.
• Bend forward.

Because of similar symptoms and presentation, providers may misdiagnose vertebrogenic pain as degenerative disk disease. But to further complicate things, some people can have both. If you have a degenerated disk in addition to damaged endplates in your lower back, you might notice additional symptoms like:

• Tingling.
• Numbness.
• Weakness.

These symptoms occur because disks can shift (or herniate) and have the potential to impinge (press) on nearby nerves (although they don’t always).

What causes vertebrogenic low back pain?

Damaged endplates in your vertebra cause vertebrogenic low back pain. And lots of things can contribute to the breakdown of your endplates, including:

• Everyday wear and tear.
• Having obesity.
• Increased height.
• Physically demanding jobs and careers.
• Family history of chronic back pain.
• Smoking.
• Trauma or fall.

How is vertebrogenic low back pain diagnosed?

First, a healthcare provider will do a physical examination. They may feel along your spine and ask you to move in specific ways to see if certain positions cause more pain. They’ll also ask about your symptoms and whether chronic back pain runs in your family.

If your provider thinks you have an issue with your spine, they’ll likely recommend imaging tests. It’s common to start with a spine X-ray to evaluate back pain. Based on your evaluation, your provider may request additional imaging like a CT (computed tomography) scan or MRI (magnetic resonance imaging). These tests may help your provider look for bone marrow inflammation and other signs of changes to your vertebral endplates.

How is vertebrogenic low back pain treated?

Providers use a few different approaches to treat vertebrogenic pain, including:

• Nonsteroidal anti-inflammatory drugs (NSAIDs). This includes medications like aspirin (Bayer®), ibuprofen (Advil®, Motrin®) and naproxen (Aleve®).
• Physical therapy. A physical therapist can teach you certain stretches and exercises that can help ease chronic low back pain.
• Muscle relaxers. In some cases, muscle relaxers can help. Because of side effects like drowsiness and physical dependence, most providers only recommend this as a short-term option.
• Intracept® procedure (basivertebral nerve ablation). If you’ve tried nonsurgical treatments for at least six months and you still haven’t seen an improvement, your provider may recommend basivertebral nerve ablation. During this procedure, a provider uses heat to ablate (damage) your basivertebral nerve to stop pain sensations from happening.

Can vertebrogenic low back pain be prevented?

You can’t always prevent vertebrogenic pain because it’s often a product of natural wear and tear. But there are things you can do to reduce your risk:

• Maintain a weight that’s healthy for you.
• Exercise regularly (including core strengthening exercises).
• Stretch often, especially if you have a sedentary job.
• Avoid smoking.

What’s the outlook for people with vertebrogenic low back pain?

People with vertebrogenic low back pain have more treatment options today compared to a few decades ago. Still, a proper diagnosis can take time — and you might have to try a couple of different treatments before you find a solution that works for you.

Statistically, the most effective treatment for vertebrogenic pain is basivertebral nerve ablation. But to qualify for coverage, you’ll probably need to try more conservative treatments first. Your healthcare provider can help you file insurance and recommend ways to reduce pain in the meantime.

When should I see my healthcare provider?

You should schedule an appointment with a healthcare provider if you develop:

• Back pain that doesn’t go away in a couple of weeks.
• Low back pain that doesn’t improve with medication.
• Worsening back pain.
• Tingling, numbness or weakness.
• You have difficulty standing or walking.