Rates of lumbar vertebral body compression fracture after basivertebral nerve ablation: A retrospective study utilizing a large national database

Background: Basivertebral nerve ablation (BVNA) is an effective treatment for vertebrogenic chronic low back pain. However, data regarding rates of post-BVNA lumbar vertebral compression fracture (VCF), particularly among patients with osteoporosis or osteopenia, remains limited. Objective: (1) Estimate the rate of lumbar VCF after BVNA. (2) Compare rates between patients with and without a pre-BVNA diagnosis of osteopenia/osteoporosis utilizing a large global database. Methods: A retrospective cohort study was performed using TriNetX, a national database of de-identified health records from over 130 million patients. Adults (≥18 years) who underwent BVNA between January 2022 and August 2025 were identified via CPT code. Patients were stratified by presence or absence of ICD-10 code for osteoporosis/osteopenia before undergoing BVNA. The primary outcome was incidence of ICD-10 code diagnosis of lumbar VCF after undergoing BVNA. Results: A total of 2387 patients underwent BVNA (mean age 63.7 years; 48.0 % female). Of these, 669 had a pre-BVNA diagnosis of osteoporosis/osteopenia (mean age 70.2 ± 10.7 years; 64.4 % female). Lumbar VCF occurred in 37 patients (1.55 %; 95 % CI, 1.11-2.16 %) after BVNA. Patients with osteoporosis/osteopenia had higher rate of post-BVNA lumbar VCF compared to those without (4.64 % vs 0.37 %), though rates of post-BVNA lumbar VCF were overall low across all patients (1.55 %). Osteoporosis/osteopenia was independently associated with post-BVNA VCF (adjusted OR 6.5; 95 % CI, 3.7-12.3; p < 0.001). Conclusion: While patients with pre-BVNA ICD-10 code diagnosis of osteoporosis/osteopenia had higher rates and were at higher risk of post-BVNA VCF than those without, overall rates were still low. Risk of VCF should be considered and risks/benefits should be discussed with patients, but a diagnosis of osteoporosis/osteopenia should not be considered an absolute contraindication to BVNA.