Diagnosing Vertebrogenic Back Pain

Outcomes

As a result of participating in this activity, learners will be better able to:

• Evaluate patients with low back pain 
• Develop a differential diagnosis for the source of pain
• Differentiate between discogenic and vertebrogenic pain

Accreditation & Designation

Release date: This activity was released 8/19/2022.

Termination date: The content of this activity remains eligible for CME Credit until 8/18/2025, unless reviewed or amended prior to this date.

Claiming Credit: Watch the entire presentation and complete the Improvement Plan/Evaluation.

Neurovations Education is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Neurovations Education designates this other activity (blended learning) for a maximum of 0.50 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Disclosure of Financial Relationships & Measures to Resolve of Conflicts of Interest

[Presenter] Zachary McCormick discloses the following financial relationships within the past 24 months: Research: Avanos Medical, Boston Scientific, Relievant Medsystems, SPR Therapeutics; Consulting: FUSmobile, Saol Therapeutics, SI Bone, Stryker

No other person with control of, or responsibility for, the planning, delivery, or evaluation of accredited continuing education has, or has had within the past 24 months, financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

All relevant financial relationships have been mitigated. Materials were reviewed in advance of the activity by person(s) that do not have conflicts of interest related to the content. In some cases, content may have been modified as part of the review and mitigation process. All clinical recommendations are evidence-based and free of commercial bias (e.g., peer-reviewed literature, adhering to evidence-based practice guidelines).

Additional Reading

• Svyrydova, N., Sereda, V., Dovgiy, I., & Shcherbaty, A. (2018). Diagnosis of vertebrogenic pain syndromes. East European Journal of Neurology, (3 (21)), 4-12.
• Albert, H. B., Briggs, A. M., Kent, P., Byrhagen, A., Hansen, C., & Kjaergaard, K. (2011). The prevalence of MRI-defined spinal pathoanatomies and their association with modic changes in individuals seeking care for low back pain. European spine journal, 20(8), 1355-1362.
• Jensen, R. K., Leboeuf-Yde, C., Wedderkopp, N., Sorensen, J. S., Jensen, T. S., & Manniche, C. (2012). Is the development of Modic changes associated with clinical symptoms? A 14-month cohort study with MRI. European Spine Journal, 21(11), 2271-2279.
• Boody, B. S., Sperry, B. P., Harper, K., Macadaeg, K., & McCormick, Z. L. (2022). The Relationship Between Patient Demographic and Clinical Characteristics and Successful Treatment Outcomes After Basivertebral Nerve Radiofrequency Ablation: A Pooled Cohort Study of Three Prospective Clinical Trials. Pain Medicine, 23(Supplement_2), S2-S13.
• McCormick, Z. L., Sperry, B. P., Boody, B. S., Hirsch, J. A., Conger, A., Harper, K., ... & Burnham, T. R. (2022). Pain location and exacerbating activities associated with treatment success following basivertebral nerve ablation: An aggregated cohort study of multicenter prospective clinical trial data. Pain Medicine, 23(Supplement_2), S14-S33.
• McCormick, Z. L., Conger, A., Smuck, M., Lotz, J. C., Hirsch, J. A., Hickman, C., ... & Burnham, T. R. (2022). Magnetic resonance imaging characteristics associated with treatment success from basivertebral nerve ablation: an aggregated cohort study of multicenter prospective clinical trials data. Pain Medicine, 23(Supplement_2), S34-S49.
• Annen, M., Peterson, C., Leemann, S., Schmid, C., Anklin, B., & Humphreys, B. K. (2016). Comparison of outcomes in MRI confirmed lumbar disc herniation patients with and without modic changes treated with high velocity, low amplitude spinal manipulation. Journal of Manipulative and Physiological Therapeutics, 39(3), 200-209.
• Schistad, E. I., Espeland, A., Pedersen, L. M., Sandvik, L., Gjerstad, J., & Røe, C. (2014). Association between baseline IL‐6 and 1‐year recovery in lumbar radicular pain. European Journal of Pain, 18(10), 1394-1401.
• Fields, A. J., Battié, M. C., Herzog, R. J., Jarvik, J. G., Krug, R., Link, T. M., ... & Sharma, A. (2019). Measuring and reporting of vertebral endplate bone marrow lesions as seen on MRI (Modic changes): recommendations from the ISSLS Degenerative Spinal Phenotypes Group. European Spine Journal, 28(10), 2266-2274.
• Dudli, S., Fields, A. J., Samartzis, D., Karppinen, J., & Lotz, J. C. (2016). Pathobiology of Modic changes. European Spine Journal, 25(11), 3723-3734.
• Conger, A., Smuck, M., Truumees, E., Lotz, J. C., DePalma, M. J., & McCormick, Z. L. (2022). Vertebrogenic Pain: A Paradigm Shift in Diagnosis and Treatment of Axial Low Back Pain. Pain Medicine, 23(Supplement_2), S63-S71.
• McCormick, Z. L. (2022). Vertebrogenic Pain: A Phenomenon Driving New Understanding of Chronic Axial Low Back Pain. Pain Medicine, 23(Supplement_2), S1-S1.
• Falowski, S., & Sayed, D. (2022). Back Pain: Vertebrogenic. In Clinical Guide to Musculoskeletal Medicine (pp. 45-50). Springer, Cham.
• Jinkins, J. R., Whittemore, A. R., & Bradley, W. G. (1989). The anatomic basis of vertebrogenic pain and the autonomic syndrome associated with lumbar disk extrusion. American journal of neuroradiology, 10(2), 219-231.
• Manfrè, L., & Goethem, J. V. (2020). Low back pain. Diseases of the Brain, Head and Neck, Spine 2020–2023, 225-230.