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The mechanism for basivertebral ablation is primarily through interrupting the nociceptive pain signals through the basivertebral nerve carried from the vertebral end plates, which is a significant source of chronic low back pain.1 The basovertebral nerve, a branch of the sinuvertebral nerve, innervates the vertebral end plates and is a major contributor to the perception of chronic low back pain. Using a small incision and a probe inserted into the vertebral body, basivertebral ablation can be performed by applying radiofrequency energy to heat and disrupt the nerve fibers within the vertebral body, thereby effectively reducing pain transmission from vertebral end plate pathology. Clinical studies have demonstrated significant pain reduction, functional improvement, and durable relief, which often lasts up to 5 years or longer.2 Usually, the approach to vertebral augmentation is a similar interpedicular approach to treat vertebral compression fractures. With kyphoplasty, a balloon is inflated to create a cavity inside the vertebral body, and then filled with cement to stabilize it. It primarily addresses the structural integrity of the fractured vertebral body. Vertebroplasty involves only injecting cement to stabilize the bone and address the structural integrity of the fractured vertebral bodies. Both approaches create an internal cast, which stabilizes the fracture, and this is the basis of the analgesic response. Vertebral augmentation with the placement of thermogenic cement may lead to ablation of the basivertebral nerve. The exothermic reaction of bone cement used in vertebral augmentation (commonly polymethylmethacrylate, PMMA) can generate peak temperatures in the core of the cement mass ranging from approximately 68°C to 77°C after injection into the vertebral body.3 Temperatures near the periphery—close to cortical bone and neural structures—are much lower, often below 45°C when no cement leakage occurs. However, temperatures can exceed this threshold if cement leaks toward sensitive areas. The critical threshold for bone and nerve damage is around 47–55°C (116.6°F–131°F), and it is possible to cause basivertebral ablation.4