ReActiv8: A Breakthrough in Multifidus Neurorehabilitation for Chronic Low Back Pain

Reactiv8 Multifidus Neurorehabilitation

The Missing Link in Chronic Low Back Pain: Multifidus Dysfunction

Chronic low back pain (CLBP) affects millions of people worldwide, often leading to disability, reduced quality of life, and reliance on medications or invasive procedures. While traditional treatments focus on pain management, one key underlying cause is frequently overlooked—multifidus muscle dysfunction.

The multifidus is a deep spinal muscle responsible for segmental stability and posture control. In many individuals with chronic low back pain, this muscle becomes inhibited and atrophied, leading to spinal instability and persistent pain.

ReActiv8®, a groundbreaking implantable neurostimulation system, directly addresses this issue by restoring neuromuscular control of the multifidus muscle, offering a novel, long-term solution for chronic low back pain.

Understanding Multifidus Dysfunction and Its Role in Chronic Pain

The multifidus muscle plays a crucial role in spinal stability, working reflexively to control small, precise movements of the vertebrae. However, in patients with chronic low back pain:

🔹 The reflexive activation of the multifidus is lost, often due to an initial injury or prolonged disuse.

🔹 This leads to muscle atrophy, reduced spinal stability, and ongoing pain.

🔹 Unlike typical muscle weakness, the multifidus does not automatically recover with exercise alone.

Traditional treatments—such as physical therapy, injections, and medications—may provide temporary relief but fail to restore proper neuromuscular activation of the multifidus.

This is where ReActiv8® comes in.

What Is ReActiv8 and How Does It Work?

ReActiv8® is an implantable neurostimulation system designed to reactivate the multifidus muscle by stimulating the L2 medial branch of the dorsal ramus, which controls the muscle's function.

🔹 Neurostimulation Therapy: ReActiv8 delivers electrical impulses to the nerve controlling the multifidus, causing targeted muscle activation and re-educating the neuromuscular system.

🔹 Restores Natural Spinal Stability: Unlike spinal cord stimulators that block pain signals, ReActiv8 restores muscle function, leading to long-term improvements in pain and mobility.

🔹 Minimally Invasive Procedure: The device is implanted through a small incision, with electrodes placed near the nerves controlling the multifidus.

Who Is a Candidate for ReActiv8?

ReActiv8 is designed for patients with chronic, nonspecific low back pain due to multifidus dysfunction, specifically those who:

✅ Have experienced chronic low back pain for six months or longer.

✅ Have failed to improve with conservative treatments (e.g., physical therapy, medications, injections).

✅ Do not have significant nerve compression (i.e., radiculopathy, sciatica).

✅ Have MRI findings consistent with multifidus atrophy and no significant structural instability (e.g., no severe disc herniations or spondylolisthesis requiring surgery).

✅ Show signs of motor control impairment rather than purely inflammatory or mechanical pain.

This makes ReActiv8 an ideal option for patients who are not candidates for spinal fusion or other invasive surgeries but still suffer from persistent low back pain.

The Treatment Process: What to Expect

1. Pre-Procedure Evaluation

• A thorough clinical assessment, including MRI and functional tests, determines if the patient has multifidus dysfunction.

• Patients may undergo a temporary external stimulation trial to assess response.

2. Minimally Invasive Implantation

• The procedure is performed under local anesthesia with sedation or general anesthesia.

• A small pulse generator is implanted in the lower back with electrodes positioned near the medial branch nerve of L2, stimulating the multifidus.

3. Rehabilitation & Neuromuscular Re-Education

• Patients use the ReActiv8 system twice daily for 30-minute sessions.

• Over several months, multifidus activation improves, leading to better spinal control and pain reduction.

4. Long-Term Recovery and Pain Reduction

• Studies show progressive improvement in function and pain levels over 1-2 years, with some patients experiencing complete resolution of chronic low back pain.

  
  

Clinical Evidence Supporting ReActiv8

ReActiv8 has been clinically validated in multiple trials, demonstrating its effectiveness for patients with multifidus dysfunction.

📌 ReActiv8-B Clinical Trial (2021):

• Long-term results showed sustained pain relief and functional improvement at 3 years.

• Over 60% of patients reported at least a 50% reduction in pain and significant improvement in quality of life (1).

📌 Multifidus Stimulation Outcomes (2022):

• Patients experienced a significant reduction in opioid use and improved functional scores (2).

📌 5-Year Follow-Up Data (2023):

• Ongoing pain relief and sustained improvement in function suggest long-lasting benefits (3).

  
  

Benefits of ReActiv8 Treatment

✔ Targets the Root Cause – Unlike spinal cord stimulators or injections, ReActiv8 restores normal neuromuscular function instead of just masking pain.

✔ Long-Lasting Pain Relief – Clinical studies show continued pain improvement even years after implantation.

✔ Minimally Invasive with Short Recovery – The implantation procedure is quick and low-risk, allowing for a rapid return to activity.

✔ Reduces Dependence on Medications – Many patients reduce or eliminate opioid use following treatment.

✔ Avoids Major Surgery – ReActiv8 provides a non-fusion, non-destructive alternative for chronic back pain sufferers.

Conclusion: Is ReActiv8 Right for You?

For patients suffering from chronic, nonspecific low back pain due to multifidus dysfunction, ReActiv8 offers a revolutionary approach to long-term pain relief. By reactivating the body's natural spinal stabilizers, this neurostimulation therapy can restore function, improve quality of life, and potentially eliminate the need for invasive spinal surgeries.

If you've struggled with chronic low back pain and haven’t found relief with traditional treatments, ReActiv8 may be the solution you've been searching for.

Interested in learning more? 

Contact our office at (435) 714-7180 today to see if you’re a candidate for ReActiv8 multifidus neurorehabilitation!

Click here for more information about Reactiv8!

References

1. Deckers K, et al. ReActiv8-B Trial: Long-Term Outcomes of Multifidus Neurostimulation.

2. Smuck M, et al. Pain Reduction and Functional Recovery Following Multifidus Stimulation. SAGE Journals

3. Gilligan C, et al. 5-Year Follow-Up on Multifidus Neurorehabilitation Outcomes. ScienceDirect

Endoscopic Medial Branch Nerve Rhizotomy vs. Traditional Percutaneous Radiofrequency Ablation: Advancing Pain Relief for Chronic Back Pain

Endoscopic Medial Branch Rhizotomy

Chronic low back pain remains one of the most challenging conditions for both patients and physicians. Among the most effective interventional techniques for facet-mediated back pain are medial branch nerve ablation procedures. Traditionally, percutaneous radiofrequency ablation (RFA) has been the gold standard for targeting these pain-generating nerves. However, recent advances in endoscopic spine interventions have introduced endoscopic medial branch nerve rhizotomy (EMBR) as a promising alternative with distinct advantages.

This blog explores the key differences between these techniques, emphasizing why the endoscopic approach may represent the future of facet joint pain treatment.

Traditional Percutaneous Radiofrequency Ablation (RFA)

Percutaneous RFA is a minimally invasive procedure that involves placing a radiofrequency probe near the medial branch nerves under fluoroscopic guidance. The probe delivers thermal energy, causing neurotomy and subsequent pain relief. This technique has been a mainstay in the management of chronic facet joint pain for decades.

Pros of Percutaneous RFA

• Minimally invasive – Requires only a small needle and fluoroscopic guidance.

• Proven efficacy – Supported by decades of research in treating facet-mediated pain.

• Outpatient procedure – Performed quickly under local anesthesia with minimal downtime.

Limitations of Percutaneous RFA

• Nerve regeneration and pain recurrence – Since RFA does not fully remove the nerve, pain often returns within 6 to 12 months as the nerve regenerates.

• Limited visualization – Fluoroscopy provides only bony landmarks, lacking direct visualization of the medial branch nerve.

• Inconsistent lesioning – Variability in electrode positioning may lead to suboptimal results.

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Endoscopic Medial Branch Nerve Rhizotomy (EMBR): A Game-Changer in Spine Interventions

Endoscopic medial branch nerve rhizotomy takes the treatment one step further by directly visualizing and ablating the nerve using an endoscope. This technique involves a small incision through which a working cannula is inserted, allowing the surgeon to use a high-definition camera to identify and sever the medial branch nerve more precisely.

Advantages of Endoscopic Medial Branch Nerve Rhizotomy

1. Direct Visualization = Improved Precision

   • Unlike percutaneous RFA, which relies on indirect landmark guidance, EMBR enables direct visualization of the medial branch nerve. This leads to more accurate nerve identification and ablation for better outcomes.

2. More Complete and Longer-Lasting Pain Relief

   • Endoscopic rhizotomy allows for mechanical severing and cauterization of the nerve, which is more effective than RFA’s thermal lesioning alone.

   • Studies suggest this results in longer pain relief compared to traditional percutaneous RFA, often extending beyond 12 to 24 months.

3. Reduced Risk of Nerve Regeneration

   • Since EMBR completely transects the nerve, the likelihood of nerve regrowth is significantly reduced compared to the thermal lesions of RFA, which leave a chance for re-innervation.

4. Addresses Additional Pain Generators

   • The endoscopic approach allows for direct debridement of inflamed tissue, removal of impinging osteophytes, and better control over pain-generating structures beyond the medial branch nerve itself.

5. Minimally Invasive with Rapid Recovery

   • Similar to percutaneous RFA, EMBR is an outpatient procedure with small incisions and minimal tissue disruption. Patients typically recover within days rather than weeks.

6. Potential for Greater Long-Term Cost-Effectiveness

   • While EMBR may have a higher initial cost than RFA, its longer-lasting relief may reduce the need for repeated procedures, making it more cost-effective in the long run.

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Who Is a Candidate for Endoscopic Medial Branch Nerve Rhizotomy?

Patients with chronic facet joint pain that has responded positively to medial branch blocks are ideal candidates for EMBR. This includes individuals who:

✅ Have persistent axial back pain unresponsive to conservative treatments.

✅ Have experienced temporary pain relief from diagnostic medial branch blocks.

✅ Seek longer-lasting pain relief compared to traditional RFA.

✅ Wish to minimize recurrence and avoid more invasive spine surgery.

Conclusion: Is Endoscopic Rhizotomy the Future of Facet Pain Treatment?

Both percutaneous RFA and endoscopic medial branch nerve rhizotomy are effective interventions for facet-mediated back pain, but the endoscopic technique offers significant advantages in precision, longevity of pain relief, and the ability to directly visualize and address pain generators.

As technology advances and endoscopic techniques become more widely adopted, EMBR is poised to redefine how we treat facet joint pain, offering patients a more durable, effective, and minimally invasive option for long-term relief.

If you or someone you know is struggling with chronic back pain and looking for an advanced, long-lasting treatment alternative to traditional RFA, consider consulting with a specialist experienced in endoscopic spine interventions.

Dr. John Hong is one of the few providers in Utah providers able to offer this newer, effective treatment for chronic back pain from painful, arthritic spinal joints.

Want to learn more? Contact our office to discuss whether endoscopic medial branch nerve rhizotomy is right for you!

Understanding Intracept: A Breakthrough in Chronic Vertebrogenic Back Pain Treatment

Chronic lower back pain can be debilitating, affecting millions of people worldwide. Traditional treatments, such as physical therapy, medication, and surgery, don’t always provide lasting relief. However, a new and innovative approach—Intracept—is offering hope for those suffering from vertebrogenic lower back pain.

What Is Intracept?

Intracept is a minimally invasive procedure designed to alleviate chronic lower back pain by targeting the basivertebral nerve (BVN). This nerve transmits pain signals from the vertebral endplates, which can become irritated due to degenerative changes. The Intracept procedure works by using radiofrequency energy to ablate the BVN, effectively disrupting pain transmission and providing long-term relief.

How Does the Intracept Procedure Work?

The Intracept procedure involves a few key steps:

1. Patient Selection – Not all back pain sufferers are candidates for Intracept. The procedure is specifically designed for individuals diagnosed with vertebrogenic pain, confirmed via MRI.

2. Minimally Invasive Approach – The procedure is performed under fluoroscopic guidance, requiring only a small incision.

3. Radiofrequency Ablation – A specialized probe delivers controlled radiofrequency energy to heat and disable the basivertebral nerve.

4. Recovery and Relief – Because it is minimally invasive, patients typically experience a short recovery time and significant pain reduction within weeks.

   
   

Benefits of Intracept

• Long-Term Pain Relief – Clinical studies have shown that patients experience sustained pain relief for at least five years post-procedure.

• Minimally Invasive – Unlike spinal fusion or other surgical interventions, Intracept requires no implants or structural modifications to the spine.

• Quick Recovery – Most patients return to daily activities within a few days to weeks.

• Opioid-Free Pain Management – By addressing the root cause of pain, Intracept reduces dependency on pain medications.

  
  

Who Can Benefit from Intracept?

The best candidates for Intracept are individuals who:

• Have chronic lower back pain lasting six months or more.

• Have MRI-confirmed Modic Type 1 or 2 endplate changes, indicative of vertebrogenic pain.

• Have not found relief with conservative treatments like physical therapy or injections.

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Final Thoughts

Intracept represents a promising advancement in pain management for those suffering from vertebrogenic lower back pain. As research continues to validate its effectiveness, more patients may find relief through this innovative procedure. If you or someone you know is struggling with chronic lower back pain, contact our team at Parkview Pain and Regenerative Institute.

For more information, visit the Boston Scientific Intracept site.