Vertebrogenic Low Back Pain

Medically Reviewed by Brunilda Nazario, MD on January 25, 2024
4 min read

Vertebrogenic pain is a type of chronic (ongoing) pain in your lower back caused by damage to vertebral endplates. An endplate is a layer of bone and cartilage at the top and bottom of each of your back bones. When these endplates are damaged, they can cause nerve pain.

Vertebrogenic pain is a newer term that comes from a big shift in the science of low back pain. For a long time, doctors thought most chronic lower back pain was caused by arthritis or a disk issue. Disks are the squishy cushions that go between your vertebrae. 

But researchers have learned that vertebral endplates are filled with nerve fibers that can cause pain when they’re compressed. That could explain a lot of cases of low back pain and point to more effective treatment.

There does appear to be a connection between disk issues and vertebrogenic pain. Researchers have found that in spots where a disk has broken down, the vertebral endplates on either side often have changes, including more pain nerve fibers than normal. But they don’t know exactly why that is.

Many things can damage your vertebral endplates and cause vertebrogenic lower back pain, including an injury or normal wear and tear.

Doctors don’t know why some people get it and others don’t, but it seems more common if you are:

  • Over age 40
  • Tall 
  • Obese 
  • A smoker 

You may be more likely to get it if you do heavy physical work, like construction, or you have a family history of chronic back pain. 

Vertebrogenic pain tends to be worse when you bend forward, sit for a long time, or when you’re physically active. You might describe your pain as deep, aching, or burning. It will mostly be along the center of your low back. You may feel fine for several days at a time, then have it flare up. 

Unlike a disk issue, vertebral endplate damage likely won’t cause numbness, tingling, or weakness. But you could have these symptoms if you have both problems. 

If you’ve had back pain (even on and off) for more than 6 months and haven’t gotten better with treatment, your doctor may test you for vertebrogenic back pain. They will diagnose you by:

  • Asking about your family history (This type of back pain can be genetic.) 
  • A physical exam where you bend in different ways to see when you have pain
  • Imaging tests  
  • Other tests to rule out things like a disk issue, tumor, or other back problem

A magnetic resonance imaging (MRI) scan will give the final answer. In this test, a machine uses magnetic fields and radio waves to make detailed pictures of your spine. 

An MRI can show changes in your endplates that could be causing your pain. They’re called Modic changes, after the radiologist who first described them. There are two types: 

  • Modic type 1. There is swelling and inflammation in your bone marrow. 
  • Modic type 2. You have yellow fatty bone marrow instead of healthy red bone marrow.

Experts are looking at another type of imaging test called a single photon emission computed tomography (SPECT) scan. This test can also show changes to your spine that would signal vertebrogenic pain. 

Your doctor likely will suggest common pain treatments like nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, or physical therapy at first. 

If these treatments don’t work after 6 months, your doctor might try a procedure called a basivertebral nerve ablation. The nerves in your vertebral endplates are branches of the basivertebral nerve, which runs through your spinal column.  The procedure damages the nerve at the point where it enters the vertebra that’s causing you pain, stopping it from sending pain signals.

Basivertebral nerve ablation

You’ll get anesthesia so you’ll sleep through the procedure and feel no pain. The surgeon makes a small cut in the skin over the damaged section of your spine. A small device is inserted into your vertebra that uses heat to damage the nerve. 

You’ll normally go home that same day. Recovery is quicker than for other kinds of back surgery. Studies have found the procedure can provide relief for 5 years or more.

Contact your doctor if back pain lasts more than a few weeks, if it’s getting worse, or if treatment isn’t working.

Let them know if you also have:

  • Numbness or tingling 
  • Trouble standing or walking
  • Loss of bladder or bowel control 
  • Sudden weight loss 
  • A fever 

The spine damage that leads to vertebrogenic pain often comes from the natural wear and tear of aging. There isn’t much you can do about it. But you can help keep your back healthy by:

  • Keeping a healthy weight 
  • Not smoking or quitting smoking
  • Standing and stretching if you sit for long periods of time 
  • Getting regular exercise 

Back issues can cause serious pain and disrupt your life. Knowing the cause can help you start on the right track to recovery.