In 2011, David fell down 17 concrete steps. Though he had no immediate pain, about a year later he noticed persistent back and neck issues. In search of pain relief, he saw an orthopedic specialist and neurosurgeon, and underwent anterior cervical discectomy with fusion (ACDF) surgery on his C3 and C4 cervical spine vertebrae, followed by ACDF on his C4 and C5 a few years later.
When lumbar pain began in 2017, he wanted to try conservative methods to alleviate the pain before considering another surgery. “I used to love riding my bike and then riding my bike became painful. I’m 6’4” and so I depend on hinging a lot. The pain was always there. I went to a chiropractor, did physical therapy, and paid out of pocket for dry needling and platelet rich plasma injections into my lumbar, but nothing was successful. I tried to power through, but I didn’t want to feel that way every single day,” recalled David.
David met with Dr. Oliver Tannous, an orthopedic spine surgeon at MedStar Washington Hospital Center, to discuss non-surgical options. As a spine specialist, Dr. Tannous emphasizes the use of non-operative treatments before considering surgery. “Every doctor I saw said my back pain wasn’t caused by a herniated disc. I did my research and talked to friends who had had more aggressive lumbar fusion surgery, and I found that the success rate is low and that most of them regretted it. I didn’t want to go that route,” said David. His MRI revealed compressed discs in his thoracic and lumbar spine that were causing most of his current pain. After conservative methods didn’t provide relief, in 2022, Dr. Tannous performed a thoracic laminectomy and lumbar microdiscectomy, which alleviated the shooting pain when arching his back. However, as Dr. Tannous cautioned pre-surgery, the nagging, dull pain in David’s lower back was still there and would most likely persist.
Dr. Tannous connected David with Dr. John Smirniotopoulos, an interventional radiologist at MedStar Washington Hospital Center and MedStar Georgetown University Hospital, to discuss a minimally invasive, image-guided basivertebral nerve ablation, called Intracept. Dr. Smirniotopoulos determined that David was an ideal candidate because his pain was vertebrogenic – central back pain caused by damaged vertebral body endplates which were apparent on his MRI – and not caused by arthritis, sports injuries, or bone or tissue injuries that do not affect the nerves. Intracept is designed specifically to treat vertebrogenic pain, where the top and bottom edges of the vertebrae in the front of the spinal column have degenerated over time due to inflammation, wear, and tear and it triggers pain from the nerves inside the vertebrae.
“Not every patient with back pain is a good candidate for the Intracept procedure. Patients with chronic lower back pain for at least six months, that is specifically in a certain area of the back, not shooting down the leg, not on the hipbone or necessarily extending along the beltline. The pain typically worsens with sitting or performing activities that require bending forward, such as when tying shoes, loading a dishwasher, or getting in and out of a car. We clinically assess every patient to determine if their symptoms match up with anterior column axial back pain, as well as assess their MRI,” said Dr. Smirniotopoulos. Two other criteria considered are if a patient has seen insufficient results from more conservative measures, and if there are ‘Modic changes’ visible on an MRI.
“Modic changes are degenerative changes in the lumbar spine, specifically the endplates that those branches of the basivertebral nerve reach,” explained Dr. Smirniotopoulos. “It could include inflammation or swelling caused by fluid, and when this is present on the MRI, coupled with the patient screening, we can determine if the Intracept procedure is a good option. This is a fairly new procedure in the Washington, DC area that we can uniquely offer to patients.”
After initial denial from David’s insurance company to cover the procedure, in July 2023, David arrived at MedStar Washington for the Intracept procedure and went home the same day. “I was in and out and the recovery was really good. I took it easy for a couple of days, but I was back to normal daily things within a day. Not one stitch involved,” recalled David.
“Once a patient is sedated with anesthesia, we access the affected vertebrae with a small needle guided by real-time x-rays. Then we create a channel through the vertebrae bone to access the trunk of the basivertebral nerve inside and use a special probe to ablate the nerve with heat from radiofrequency energy,” explained Dr. Smirniotopoulos. “This deadens the nerve, rendering it unable to send pain signals to the brain, without hindering mobility or weakening the spine. The entire procedure takes about an hour and there are no sutures, no stitches, just Band-Aids.”
It’s typical after the Intracept procedure for changes in pain level to not feel immediate. About 10 days after the procedure, David woke up in the morning and realized the nagging pain in his lower back was less intense. Another week or two later and he said the pain was completely gone. “I never gave up because I wasn’t going to live in pain. After 8 years of surgeries, procedures, and therapies, my pain was finally relieved,” said David. “Every third person I know has back pain and I really think this could help a lot of people.”
“Like David, who had been suffering for years, by the time most patients come to me, they’ve tried a lot of things that haven’t worked,” shared Dr. Smirniotopoulos. “I never tell my patients we can guarantee they will have zero pain. Our goal is to reduce the pain to a level where patients can participate in the activities they want to enjoy and have a higher quality of life. I’m so happy for David and his results and that he’s regained a part of his life.”
Today, David enjoys a variety of activities again, from the mundane, like bending while washing dishes, to the more active, “I’m back to riding my mountain bike on trails and I work out regularly at the gym. I used to not be able to tolerate being on my feet for more than an hour but now I can even go to a festival or go to the mall in Washington and to museums and walk around for hours with no issues. I didn’t want to get my hopes up after everything else I had tried, but now I’m so pleasantly surprised by the outcome. It totally worked for me.”