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Minimally invasive lumbar decompression (MILD) is a procedure that helps alleviate back pain and other symptoms in people with lumbar spinal stenosis.

Lumbar spinal stenosis (LSS) is a common cause of low back pain. The prevalence of symptomatic lumbar spinal stenosis is about


11% of the population and increases with age.

Although other treatments for LSS exist, they do not all work for everyone. Additionally, more invasive spinal surgery is also not the best choice for all patients. Other surgical procedures for lumbar stenosis require general anesthesia and large incisions.

MILD offers an additional safe and effective treatment for lumbar stenosis for people with moderate to severe lumbar spinal stenosis.

The information below covers how doctors perform a MILD, the benefits, and what to expect during recovery.

What is a minimally invasive lumbar decompression (MILD)?

Minimally invasive lumbar decompression, also known as MILD, is a procedure used to treat lumbar spinal stenosis. It does not require a large incision and helps reduce pressure on the spinal nerves.

As we age, a ligament in the back, the ligamentum flavum, may become thicker. A MILD procedure removes the thickened ligament, helping create more space in the spinal canal and reducing pressure on the spinal nerves.

If conservative therapies, such as physical therapy and epidural steroid injections, have not reduced pain, a MILD procedure may help.

What is lumbar spinal stenosis (LSS)?

Lumbar spinal stenosis (LSS) is a condition in the lower back that occurs when the spinal canal, or the space around the spinal cord, becomes smaller. This is often caused by typical wear and tear associated with aging, leading to the spine's structure degeneration.

Although spinal stenosis can occur in any segment of the spine, it


most commonly develops in the lumbar spine.

LSS may develop for a variety of reasons, including a bulging disk, arthritis, and injuries. Other symptoms may also develop, such as:

• Numbness and tingling in the feet
• Loss of sensation in the feet
• Burning pain in the buttocks that radiates down the legs

Lumbar spinal stenosis can make everyday activities difficult.

One characteristic symptom of lumbar stenosis is position- or exercise-induced neurogenic claudication. This means that walking or lumbar extension may worsen symptoms, but lumbar flexion may make symptoms disappear.

How is a MILD procedure for spinal stenosis performed?

A MILD procedure is performed under sedation and a local anesthetic. The physician uses imaging technology and specialized surgical tools to perform a MILD procedure for back pain.

Typically, the procedure involves only a small incision. The doctor advances a specific type of needle through the incisions to the ligamentum flavum. The procedure involves shaving the ligament to decrease thickness. The result is more space for the spinal nerves and less compression. Removing excess ligament tissue and easing compression usually reduces pain.

MILD procedure risks

A MILD back procedure is generally safe and low risk. But with any type of procedure, there are risks. Possible risks of a MILD include:

• Bleeding
• Infection
• Inadequate pain relief

Studies report an excellent safety profile with little to no evidence of spinal instability through the two-year follow-up.

Are you a candidate for a MILD procedure?

Identifying appropriate candidates is vital to ensure the best possible outcome for the procedure. To determine if you are a good candidate for minimally invasive lumbar decompression, it is best to come in for a consultation.

In general, patients who have lumbar spinal stenosis with thickened ligaments may be a good candidate. Additional


indications for the mild procedure include:

• Lumbar stenosis with neurogenic claudication
• Symptoms that continue for more than three months
• Limited or no reduction in pain with conservative treatment, such as physical therapy
• Imaging evidence of ligamentum flavum thickness of ≥ 2.5 mm
• Central canal cross-sectional area of ≤ 100 mm

Are there contraindications for having a MILD procedure?

Not everyone is an appropriate candidate for a MILD procedure for lumbar stenosis. Certain factors prevent some people from getting the procedure. As always, it is best to have an exam and evaluation to determine the best treatment options for lumbar spinal stenosis.

In general, some of the


contraindications for a MILD procedure for spinal stenosis include:

• Symptomatic significant disc herniations
• Lumbar spondylolisthesis > Grade 1
• Inability to walk greater than 10 feet without an assisted device
• Bleeding disorder
• History of prior surgery at the same treatment level

Benefits of having a MILD procedure

It can be frustrating not to get pain relief from conservative therapies, such as epidural steroid injections and physical therapy.

MILD lumbar stenosis can restore mobility, reduce pain, and improve other symptoms, such as tingling radiating down the leg.

Because a MILD takes a minimally invasive approach, it typically means a quicker recovery than traditional surgery, which requires larger incisions.

Some of the benefits of a MILD procedure include:

• It is performed as an outpatient procedure, meaning you can go home the same day
• Small incisions reduce the risk of infection and bleeding
• The ability to walk further with less pain
• Less trauma to surrounding tissue since MILD is minimally invasive
• You can typically return to normal activities within a few days

Side effects of a MILD procedure

Side effects from a MILD back procedure usually only last a brief time. Possible side effects include grogginess or soreness at the incision site.

Preparing for a MILD procedure for back pain

You may be instructed to hold or adjust certain medications for a few days or longer before the procedure to reduce the risk of excess bleeding. However, do not stop taking medications on your own. Wait for instructions from the doctor.

On the day of the MILD, you will likely be instructed not to eat for six hours or more before the procedure. This is to reduce the risk of nausea and vomiting.

What happens immediately after a MILD?

A MILD procedure typically takes an hour. After the procedure, you are observed in the recovery room until the anesthesia wears off. You may be instructed not to swim, sit in a hot tub, or bathe the day you have the procedure.

Although it may vary, most people are up walking around in a few days and can do most of their normal activities.

In some cases, your doctor may recommend going to physical therapy. You may also have a postoperative appointment a few weeks after the procedure and again at 6 weeks after to assess pain relief and make sure healing is going well.

Common questions regarding a MILD procedure

Here are some of the most common questions about the MILD procedure.

Does a MILD procedure provide pain relief?

The MILD procedure relieves pressure on the spinal nerves, which usually provides pain relief for people with lumbar spinal stenosis (LSS). After space is created in the spine and pressure is reduced, pain typically resolves.

In some cases, individuals may have multiple issues causing back pain. While a MILD procedure addresses issues related to lumbar spinal stenosis, it does not treat all conditions that may be causing back pain.

What is the success rate of a MILD procedure?

The success rate for a MILD procedure is high for individuals who are appropriate candidates. The exact success rate as defined by pain relief and improved mobility varied by study.

Research

indicates that 88% of patients who underwent the MILD reported reduced pain and avoided back surgery for at least five years. Patients reported walking 16 times further after the procedure and standing seven times longer.

What is recovery like for a MILD back procedure?

Although recovery timelines may vary, most people heal quicker after a MILD back procedure than other forms of open surgery for lumbar stenosis. Although it may vary, most people can resume normal activities in a few weeks.

Unless someone has complications or has a very physically active job, most people can return to work within a short time after the procedure.

You will likely receive instructions to avoid strenuous activities like heavy lifting. After a recovery period, you should notice a significant improvement in pain.

Following your post-operative instructions, such as physical restrictions and wound healing, will promote optimal healing.

Is a MILD procedure covered by insurance?

The MILD procedure is covered by

Medicare. Commercial insurance coverage may vary. Talk with your insurance provider to determine coverage specifics.

Is a MILD Procedure Right for You?

Lumbar spinal stenosis can lead to problems walking and doing everyday activities. It can also cause chronic pain.

A MILD procedure uses a minimally invasive approach to reduce back pain due to lumbar spinal stenosis. It removes the thickened ligament for people who do not respond to conservative treatment, creating space in the spinal canal and easing nerve compression. A MILD may be effective for people with moderate to severe lumbar spinal stenosis.

If you have any questions about the mild procedure or want to schedule a consultation, please

contact us today!

References:

1. Yuan H, Yi X. Lumbar Spinal Stenosis and Minimally Invasive Lumbar Decompression: A Narrative Review. J Pain Res. 2023 Nov 6;16:3707-3724. doi: 10.2147/JPR.S428112. PMID: 37954472; PMCID: PMC10637222.
2. Lumbar spinal stenosis. (2024, June 7). Johns Hopkins Medicine.
   
   https://www.hopkinsmedicine.org/health/conditions-and-diseases/lumbar-spinal-stenosis
3. Staats PS, Chafin TB, Golovac S, Kim CK, Li S, Richardson WB, Vallejo R, Wahezi SE, Washabaugh EP 3rd, Benyamin RM; MiDAS ENCORE Investigators. Long-Term Safety and Efficacy of Minimally Invasive Lumbar Decompression Procedure for the Treatment of Lumbar Spinal Stenosis With Neurogenic Claudication: 2-Year Results of MiDAS ENCORE. Reg Anesth Pain Med. 2018 Oct;43(7):789-794. doi: 10.1097/AAP.0000000000000868. PMID: 30199512; PMCID: PMC6319572.
4. Mekhail N, Costandi S, Nageeb G, Ekladios C, Saied O. The durability of minimally invasive lumbar decompression procedure in patients with symptomatic lumbar spinal stenosis: Long-term follow-up. Pain Pract. 2021 Nov;21(8):826-835. doi: 10.1111/papr.13020. Epub 2021 May 13. PMID: 33942964; PMCID: PMC9291913.