Spinal fusion surgery is one of the most commonly performed major spine operations in the United States. It is appropriate for certain structural problems, such as instability or severe deformity. But there is a specific type of chronic low back pain that often does not improve after fusion, and many patients are not having this conversation before they agree to the operation.
The reason comes down to where the pain is actually coming from. For some patients, particularly those with a finding on MRI called Modic changes, the pain originates in the vertebral endplates, the thin layer of bone at the top and bottom of each disc. This is sometimes called vertebrogenic pain. Fusion surgery addresses the disc and the joint between two vertebrae, but it does not target the basivertebral nerve, which is the nerve that carries pain from the vertebral body itself. When vertebrogenic pain is the primary issue, fusion may not relieve it, even if the surgery goes well from a technical standpoint.
The Intracept procedure is designed to address this specific source of pain by ablating the basivertebral nerve through a minimally invasive approach. At our Garden City practice, we are a designated center of excellence for this procedure, and we have found it to be an important option for patients who are trying to understand what is causing their pain before making a decision about major surgery.
What Modic Changes Mean for Your Back Pain
Modic changes are a finding on MRI that reflects inflammation or degeneration in the vertebral endplates. They are more common in patients with chronic low back pain than in those without it. Not all Modic changes cause pain, but research has shown that a meaningful portion of patients with chronic axial low back pain are experiencing pain that comes primarily from the endplates rather than from disc herniation, facet joints, or other structures.
These patients may have had disc injections, facet blocks, or epidural steroids without lasting benefit. The reason is that those treatments target different pain generators. The endplate and the basivertebral nerve that supplies it require a different approach.
When someone with Modic changes and axial low back pain has not responded to conservative care and is being evaluated for fusion surgery, it is worth asking whether vertebrogenic pain is a significant contributor. If it is, addressing that source first may be more appropriate than proceeding directly to fusion.
How the Intracept Procedure Works
The Intracept procedure ablates the basivertebral nerve using radiofrequency energy delivered through a probe that is advanced into the vertebral body through a small skin incision. There is no disc removed, no joint fused, and no hardware left behind. The procedure is done under sedation and takes under an hour in most cases. Patients go home the same day.
By interrupting the basivertebral nerve, we can eliminate or significantly reduce pain signals coming from the vertebral endplate. For patients in whom this is the dominant pain source, this can produce meaningful and lasting relief.
This is an outpatient procedure. The recovery is far less involved than fusion surgery, and there is no restriction on future treatment options. If someone has Intracept and still requires surgery for other reasons, fusion remains possible.
Using Intracept to Reduce the Risk of Persistent Pain After Fusion
Published data suggests that approximately 15 percent of patients who undergo lumbar spinal fusion continue to experience chronic low back pain even after technically successful surgery. In many of these cases, the surgery itself was not a failure. The problem was that the dominant pain generator was not the one that was treated.
When a patient has Modic changes and axial low back pain, and fusion is being planned, Intracept offers a way to address the vertebrogenic component directly. In some cases, patients who undergo Intracept find sufficient relief that the urgency for fusion decreases or the decision changes entirely.
For patients who have already had fusion and still have significant back pain, Intracept can also be considered if there are Modic changes at levels not previously treated.
Questions Worth Asking Before You Commit to Fusion
If you have been recommended for lumbar spinal fusion for axial low back pain, it is worth discussing a few specific questions with your surgeon or a pain management specialist before proceeding:
Does my MRI show Modic changes at the level or levels being considered for fusion?
Could vertebrogenic pain be a significant contributor to my symptoms?
Have I been evaluated by an interventional pain specialist as part of the workup?
What is the expected outcome if vertebrogenic pain is present and is not addressed?
We work with referring surgeons across Nassau County and Long Island as part of a collaborative process. Getting a pain management evaluation before surgery is not about delaying necessary care. It is about making sure the right diagnosis is confirmed and the right treatment is chosen.
Frequently Asked Questions About Intracept
How do I know if I have Modic changes?
Modic changes are visible on MRI of the lumbar spine. Your radiologist's report may mention them, or we can review your imaging during a consultation.
Can Intracept be done at the same level as a prior fusion?
Generally not at an already fused level, but it can be considered at adjacent levels where Modic changes are present.
How long does the relief from Intracept last?
Clinical data shows durable relief in appropriate candidates, with follow-up studies extending to two years showing maintained benefit.
Does insurance cover the Intracept procedure?
Coverage continues to expand. Medicare and many commercial plans cover Intracept in patients who meet specific criteria. Our team can check your benefits during the consultation process.
Get a Full Evaluation Before Making a Decision About Spine Surgery
If you have been told you need spinal fusion for back pain, a consultation at our practice can help clarify whether there are additional factors contributing to your symptoms and whether less invasive options are appropriate. Dr. Rubin is a designated Intracept Center of Excellence provider serving patients across Nassau County, Queens, and Long Island. Call 516-492-3100 or text 516-206-0774 to schedule.
Written by Dr. Edward Rubin, MD, board-certified in Pain Medicine and Anesthesiology, with fellowship training at Cornell, Columbia, Hospital for Special Surgery, and Memorial Sloan Kettering. Dr. Rubin has been treating chronic pain patients on Long Island for over 20 years.
