By the Pain Management Team at Performance Pain and Sports Medicine
Suzanne Manzi, MD · Matthias Wiederholz, MD · Jade Nemeth, PA-C
Updated April 2026
Medically Reviewed By: Dr. Matthias Wiederholz, MD
On This Page:
- What Is the Intracept Procedure?
- Understanding Vertebrogenic Pain
- Who Is a Candidate for the Intracept Procedure?
- How the Intracept Procedure Works
- Benefits of the Intracept Procedure
- Risks and Side Effects
- Intracept vs. Radiofrequency Ablation
- Recovery and What to Expect
- Why Choose Performance Pain and Sports Medicine in Houston
- Our Houston Location
- Frequently Asked Questions
Chronic low back pain affects millions of adults and remains one of the leading causes of disability worldwide. For many patients, months or years of physical therapy, medications, and injections fail to produce lasting relief. When standard treatments fall short, the underlying cause may be vertebrogenic pain, a specific type of back pain that originates inside the vertebral bones themselves.
The Intracept procedure, also called basivertebral nerve ablation, is an FDA-cleared, minimally invasive treatment designed to target this source of pain directly. At Performance Pain and Sports Medicine, led by quadruple board-certified physicians, patients in Houston have access to advanced diagnostic tools and interventional techniques for identifying and treating vertebrogenic low back pain. A 5-year pooled analysis of 249 patients showed durable improvements in both pain and function following basivertebral nerve ablation (Khalil et al., Interv Pain Med, 2024).
What Is the Intracept Procedure?
The Intracept procedure is a minimally invasive, outpatient treatment that uses radiofrequency energy to ablate (heat and disable) the basivertebral nerve inside the vertebral body. The basivertebral nerve (BVN) is a small nerve that runs through the center of each vertebra in the lower spine. When the endplates of vertebral bones become damaged or inflamed, the BVN transmits chronic pain signals to the brain.
Unlike traditional nerve ablation procedures that target nerves near the facet joints on the outside of the spine, the Intracept procedure targets the nerve inside the bone itself. This is an important distinction. The procedure is FDA-cleared, requires no permanent implant, and preserves the structural integrity of the spine.
A sham-controlled randomized trial of 225 patients demonstrated that basivertebral nerve ablation produced significantly greater improvements in disability scores compared to a placebo procedure (Fischgrund et al., Eur Spine J, 2018). This level of evidence, tested against a sham control, is considered the gold standard in clinical research.
Understanding Vertebrogenic Pain
Vertebrogenic pain is chronic low back pain caused by damage to the vertebral endplates, the thin layers of cartilage and bone that sit between each vertebra and the spinal discs. When these endplates become inflamed or degenerate, characteristic changes called Modic changes appear on MRI scans.
Modic changes are classified into types based on their MRI appearance and represent different stages of endplate damage (Wen et al., Skeletal Radiol, 2025). Type 1 changes indicate active inflammation, while Type 2 changes reflect fatty replacement of bone marrow at the endplate. Both types can stimulate the basivertebral nerve and produce chronic pain.
Vertebrogenic pain is different from disc-related pain or facet joint pain, though these conditions can overlap. Patients with vertebrogenic pain often describe a deep, aching low back pain that worsens with sitting or standing for long periods. Standard back pain treatment approaches such as physical therapy and epidural injections may not fully address this pain source because they do not reach the nerve inside the vertebral body.
Who Is a Candidate for the Intracept Procedure?
The Intracept procedure is designed for a specific group of patients. Candidates typically meet the following criteria:
- Chronic low back pain lasting 6 months or longer
- Failure to achieve adequate relief from at least 6 months of conservative treatment (physical therapy, medications, injections)
- MRI evidence of Modic Type 1 or Type 2 changes at one or more levels between L3 and S1
- Pain that is primarily axial (centered in the low back) rather than radiating down the legs
These criteria are based on the inclusion standards used in the SMART randomized controlled trial (Fischgrund et al., Eur Spine J, 2018).
Patients who may not be candidates include those with:
- Spinal instability or significant spinal deformity
- Active spinal infection
- Radiculopathy (nerve root compression) as the primary pain source
- Pregnancy
A thorough evaluation, including MRI review and clinical assessment, is necessary to determine whether vertebrogenic pain is the primary driver of symptoms.
How the Intracept Procedure Works
The Intracept procedure follows a three-step pathway from diagnosis to treatment.
Step 1: Diagnostic Evaluation. The treating physician reviews the patient’s MRI to confirm the presence of Modic changes at the affected spinal levels. A clinical assessment determines whether the patient’s pain pattern is consistent with vertebrogenic pain. This step ensures that the procedure targets the correct pain source.
Step 2: The Procedure. The Intracept procedure is performed as an outpatient surgery, typically lasting about one hour. The patient receives light sedation. Using fluoroscopic (live X-ray) guidance, the physician places a small probe through the outer bone of the vertebra and into the vertebral body. Radiofrequency energy is then delivered to the basivertebral nerve, creating a targeted lesion that disrupts the pain signal. The probe is removed, and no implant is left behind.
A randomized trial comparing basivertebral nerve ablation to continued standard care was halted early by an independent safety committee because the treatment group showed such significant improvement, with a 25.3-point reduction in disability scores compared to 4.4 points for standard care (Khalil et al., Spine J, 2019).
Step 3: Recovery. Patients are discharged the same day. Specific activity modifications during the initial recovery period are discussed before discharge.
Benefits of the Intracept Procedure
Clinical evidence suggests several potential benefits for appropriately selected patients:
- Durable pain relief. Pooled data from three clinical trials showed a mean pain reduction of 4.32 points (on a 0-10 scale) sustained through 5 years. Approximately 32% of patients reported being completely pain-free at the 5-year mark (Khalil et al., Interv Pain Med, 2024).
- Reduced need for opioids. Among patients who were using opioids before the procedure, 65% had discontinued opioid use by 5 years.
- Minimally invasive with no implant. The procedure preserves spinal anatomy and does not require hardware, fusion, or permanent devices.
- Improved function. Five-year follow-up from the SMART trial demonstrated that 66% of treated patients achieved at least a 50% reduction in pain, with a 75% composite responder rate for both pain and function (Fischgrund et al., Eur Spine J, 2020).
- Reduced need for additional procedures. Spinal injection use decreased by 58%, and only 6% of treated patients went on to have lumbar fusion surgery over the 5-year follow-up period.
Risks and Side Effects
The Intracept procedure has demonstrated a strong safety profile across published clinical trials. Across three prospective studies involving over 300 treated patients followed for up to 5 years, zero serious device-related adverse events were reported (Khalil et al., Interv Pain Med, 2024).
Possible side effects may include:
- Temporary soreness or discomfort at the procedure site
- Minor bruising near the insertion point
- Rare risk of infection, as with any procedure involving needle insertion
As with any medical procedure, individual results vary. The treating physician discusses all potential risks and benefits during the pre-procedure consultation.
Intracept vs. Radiofrequency Ablation
Patients researching pain management options often ask how the Intracept procedure compares to traditional radiofrequency ablation (RFA). While both use radiofrequency energy to treat nerves, they target different structures and address different types of back pain.
| Feature | Intracept (BVN Ablation) | Traditional RFA (Medial Branch) |
|---|---|---|
| Target nerve | Basivertebral nerve (inside the vertebral body) | Medial branch nerves (near facet joints) |
| Pain source treated | Vertebrogenic pain (endplate/Modic changes) | Facet joint pain |
| Diagnostic confirmation | MRI showing Modic changes | Positive medial branch block response |
| Durability of relief | 5-year data shows sustained improvement | Typically requires repeat procedures every 6-18 months |
| Procedure location | Inside the vertebral bone | Outside the spine, near facet joints |
Proper diagnosis determines which procedure is appropriate. Traditional RFA treats facet-mediated pain, while the Intracept procedure treats vertebrogenic pain originating inside the vertebral body.
Recovery and What to Expect
Most patients leave the outpatient facility the same day as the procedure. Recovery is generally quicker than more invasive spinal surgeries.
First 1-2 weeks: Patients may experience mild soreness at the procedure site. Most can resume light daily activities within a few days. Heavy lifting and high-impact exercise are typically restricted during this initial period.
Weeks 2-4: Activity levels gradually return to normal. Many patients begin to notice meaningful improvement in their pain during this window.
Months 1-3: Maximum benefit may take up to 3 months to develop. Clinical trial data shows improvements continue to build during this period and are sustained through 5 years of follow-up.
The treating physician provides specific post-procedure instructions tailored to each patient’s activity level and treatment plan.
Why Choose Performance Pain and Sports Medicine in Houston
When patients choose the Intracept procedure at the Houston practice, they benefit from a physician-led care team with advanced training in interventional spine procedures and basivertebral nerve ablation for vertebrogenic pain.
Dr. Matthias Wiederholz, MD — Quadruple Board-Certified in Physical Medicine & Rehabilitation, Sports Medicine, Pain Medicine, and Anti-Aging, Regenerative & Functional Medicine — is the founder of Performance Pain and Sports Medicine and has been treating complex spine and pain conditions since 2009. His interventional spine background and experience with fluoroscopy-guided radiofrequency procedures align closely with the diagnostic precision required for the Intracept procedure.
The Intracept program also draws on the expertise of Dr. Suzanne Manzi, MD — Quadruple Board-Certified in Physical Medicine & Rehabilitation, Pain Medicine, Electrodiagnostic Medicine, and Obesity Medicine — who is fellowship-trained at Michigan State University in Interventional Spine and Pain Management and serves on teaching faculty at UT Health Houston McGovern Medical School.
Jade Nemeth, PA-C supports patients through every stage of the Intracept pathway, from initial MRI review through post-procedure follow-up.
What sets the Houston practice apart:
- Physician-led care with fellowship-trained expertise in interventional spine procedures
- Careful MRI review and candidacy evaluation before any procedure is recommended
- Dedicated one-on-one consultation time
- Same-day outpatient treatment with no permanent implant
- Convenient Houston office in the T-Mobile Tower near the Galleria, accessible from River Oaks, West University, and the greater Houston area
At PPSM, the right approach to chronic back pain starts with accurate diagnosis. When vertebrogenic pain is the driver, the team guides patients through every step — from MRI review to procedure to long-term follow-up.
Our Houston Location
Performance Pain and Sports Medicine occupies Suite 1700 of the T-Mobile Tower, providing a convenient Houston pain management location for patients from River Oaks, the Galleria, Bellaire, West University, and Montrose. The building offers covered parking with validation.
Performance Pain and Sports Medicine — Houston:
Address: 4126 Southwest Freeway, Suite 1700, Houston, TX 77027
Landmark: T-Mobile Tower, 17th Floor
Phone: 346-217-1111
Major Cross Streets: I-59 (Southwest Freeway) at 610 (West Loop)
Parking: Covered garage with validation provided
Nearby Neighborhoods: River Oaks, Galleria, Bellaire, West University, Montrose
Frequently Asked Questions
How much does the Intracept procedure cost?
The cost varies depending on insurance coverage, the number of spinal levels treated, and the facility. Many commercial insurance plans and Medicare now provide coverage for basivertebral nerve ablation. A cost-effectiveness analysis found the procedure highly cost-effective compared to ongoing standard care (Smuck et al., Spine J, 2024). The billing team at Performance Pain and Sports Medicine can verify coverage and provide estimates before scheduling.
Is the Intracept procedure permanent?
The Intracept procedure creates a permanent lesion on the basivertebral nerve. Published 5-year follow-up data shows that pain relief and functional improvement are sustained over time, with no evidence of diminishing results. Current evidence suggests a single procedure may provide lasting benefit.
What is the recovery time for the Intracept procedure?
Most patients resume light activities within a few days and return to normal routines within 2-4 weeks. Full benefit from the procedure may take up to 3 months to develop. Recovery is significantly shorter than lumbar fusion or other open spine surgeries.
Is the Intracept procedure the same as nerve ablation?
The Intracept procedure is a type of nerve ablation, but it differs from traditional radiofrequency ablation. Traditional RFA targets medial branch nerves near the facet joints, while the Intracept procedure targets the basivertebral nerve inside the vertebral body. They treat different pain sources and require different diagnostic criteria.
Does Medicare cover the Intracept procedure?
Medicare has established coverage for basivertebral nerve ablation. Coverage may vary by region and specific Medicare plan. The practice staff can assist with verifying Medicare benefits and obtaining any required prior authorization before the procedure is scheduled.
Who is not a candidate for the Intracept procedure?
Patients who may not be candidates include those with spinal instability, active spinal infection, pregnancy, or pain primarily caused by nerve root compression (radiculopathy). An MRI must show Modic Type 1 or Type 2 changes for a patient to be considered. Candidacy is determined through a complete evaluation including imaging review.
What are the pros and cons of the Intracept procedure?
Potential advantages include durable pain relief sustained through 5 years, no permanent implant, same-day outpatient procedure, reduced opioid use, and a strong safety record. Potential drawbacks include the requirement for a specific diagnosis (Modic changes on MRI), variable insurance coverage, and the fact that not all patients respond. Outcomes vary by individual.
How do I know if I have vertebrogenic pain?
Vertebrogenic pain is diagnosed through clinical evaluation and MRI imaging. The key diagnostic marker is the presence of Modic changes on MRI at the affected spinal levels. Patients with vertebrogenic pain typically have chronic, axial (non-radiating) low back pain that has not responded to conservative treatments. A pain management physician can review imaging and symptoms to determine whether vertebrogenic pain is the likely cause.
Schedule Your Intracept Consultation in Houston
If chronic low back pain has not improved with physical therapy, medications, or injections, the Intracept procedure may be worth discussing. The Houston pain management team at Performance Pain and Sports Medicine offers MRI-based candidacy evaluations and same-day outpatient treatment. Request an appointment to find out whether basivertebral nerve ablation could help.
MEDICAL DISCLAIMER
This article is for educational purposes only and does not replace professional medical advice, diagnosis, or treatment. The information presented reflects an interventional pain management perspective and is intended to support, not substitute, your relationship with a qualified healthcare provider. Individual results vary based on diagnosis, pain duration, overall health, and response to treatment. Some procedures may not be covered by insurance. Treatment outcomes depend on proper patient selection and accurate diagnosis. Always consult a board-certified physician before pursuing any pain management treatment.
Medically reviewed by Matthias Wiederholz, MD
Board-Certified in Physical Medicine & Rehabilitation, Sports Medicine, Pain Medicine, and Anti-Aging, Regenerative & Functional Medicine
Last reviewed: April 2026
