Abstract
INTRODUCTION: Schroth therapy improves outcomes in mild degenerative scoliosis but may be insufficient for patients with vertebrogenic pain linked to vertebral endplate changes. Basivertebral nerve ablation (BVNA) is a novel intervention that may provide additional benefit in these cases. METHODS: This retrospective, propensity score-matched cohort study included adults aged ≥ 18 years with idiopathic or degenerative scoliosis (Cobb angle ≥ 20°) and vertebrogenic pain, treated between January 1, 2020 and January 31, 2024, across two major healthcare systems. A subset received BVNA between December 5, 2022 and December 5, 2024. Propensity score matching was performed 1:1 for age, sex, body mass index, baseline disability and pain scores, and prior therapy sessions, yielding 44 matched patients (22 per group). The primary outcome was ≥ 15-point improvement in Oswestry Disability Index (ODI) at 12 months. Secondary outcomes included ≥ 3-point pain reduction, opioid and health-resource utilization, and complications. RESULTS: Among 76 patients (mean [standard deviation] age 68.8 [14.8] years; 82.9% female), 44 were included in the matched analysis. At 12 months, patients receiving Schroth therapy plus BVNA achieved greater ODI improvement (mean change - 22.3 vs - 15.1; P = 0.03) and were more likely to reach ≥ 15-point ODI improvement (81.8% vs 59.1%; OR 2.58 [95% CI 1.01-6.60]; P = 0.048). Opioid use declined more in the BVNA group (- 37% vs - 14%, P = 0.037), with progressive MEDD reduction (19 → 10 mg) compared with stable use in the Schroth-only group (17 → 17 mg; group × time P = 0.003). Rates of subsequent pain procedures (81.8% vs 13.6%, P < .001) and ER visits for chronic back pain (63.6% vs 9.1%, P = 0.0004) were higher for Schroth-only patients. No complications were reported. CONCLUSION: In adults with scoliosis and vertebrogenic pain, combining BVNA with Schroth therapy was associated with superior outcomes at 12 months compared with Schroth therapy alone.