BACKGROUND: Vertebral osteomyelitis (VO) frequently results in persistent vertebrogenic back pain (VBP) due to ongoing endplate inflammation and structural damage despite infection-directed therapy. The application of basivertebral nerve radiofrequency ablation (BVNRFA) for VBP resulting from vertebral infection has not been explored in the current literature.

CASE REPORT: A 53-year-old man with poorly controlled diabetes and recurrent L3-L4 osteomyelitis underwent multiple hospitalizations for sepsis and progressive vertebral body destruction. Serial magnetic resonance imaging demonstrated chronic L3-L4 osteomyelitis with marrow edema, and 2 persistent enhancing fluid pockets, but no surgically drainable epidural abscess. Despite prolonged intravenous antibiotics and the absence of operative indications, severe axial lumbar pain continued with significant functional limitation. BVNRFA was performed to target nociceptive signaling originating from chronically diseased vertebral endplates. The intervention was tolerated without complications and resulted in meaningful improvement in axial pain and mobility.

CONCLUSION: Our case illustrates a novel application of BVNRFA for VBP associated with chronic VO.

KEYWORDS: Osteomyelitis, basivertebral nerve, case report, radiofrequency ablation, vertebral body