It is estimated that around 80% of Americans will experience back pain in their lives. There are many different causes of back pain, many different associated symptoms, and just as many treatments available. One of the more feared treatments have been back surgery, since, until recently, it is most of the time severely invasive, and comes with an extended recovery time. However, for certain types of back pain, a newer, less invasive procedure has been developed, aptly named Minimally Invasive Lumbar Decompression, or MILD. If lumbar spinal stenosis, or LSS, is the culprit, then MILD may be the treatment.
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In order to understand what the MILD procedure it, it is important to know what LSS is. Lumbar spinal stenosis means a narrowing or pinching (stenosis) around the lower (lumbar) part of the spinal cord. The spinal cord rests in the spinal canal, which is a tunnel in back part of the vertebrae. This tunnel is comprised of vertebral bones stacked on top of each other, with a disc in between them, and ligaments that run up and down keeping these bone/disc stacks both sturdy and mobile. Years of wear and tear on the back can cause the discs to bulge, the bony joints to swell, or the ligaments to enlarge. Normally, the spinal cord has plenty of room in its spinal canal home, but if any of those wear and tear side effects occur, this can bulge, swell, or enlarge into the canal, and cause compression of the spinal cord. This compression is responsible for back pain, and pain, numbness, tingling sensations that go down the legs. The pain is typically worsened with standing or walking, and relieved with leaning forward or sitting.
If the cause of the spinal stenosis and the pain symptoms is enlarged ligaments, that’s where the MILD procedure can help. This procedure involves a special, spoon-like tool that scrapes off the extra ligament that is pushing on to the spinal cord, and suctioning it out. The incision is about 5mm long, about the width of a baby aspirin, so no stitches or staples are required. The procedure is done with local anesthesia and IV sedation, not full anesthesia, which makes recovery time quicker. After the procedure, patients are able to walk out of the hospital, no bed-bound recovery. Risks of the procedure include infection and increased bleeding, but the complication rate is very rare, and the procedure has been demonstrated to be as safe as epidural steroid injections.
There are many therapies for back pain that help relieve the symptoms, and improve functionality, but are not correcting the problem itself. There are many surgeries to correct the problem, but they can involve high risk, and lengthy recovery times. The MILD procedure is a way to correct the issue causing the pain, without the difficulties associated with an invasive spinal surgery.
Deer TR, Mekahil N, Lopez G, Amirdelfan Kasra. (2010), Minimally Invasive Lumbar Decompression for Spinal Stenosis. The Evolving Treatment of Pain, 1(S1): 29-32
Mekhail, Nagy, et al. (2012), Functional and Patient-Reported Outcomes in Symptomatic Lumbar Spinal Stenosis Following Percutaneous Decompression. Pain Practice, 12(6): 417–425. doi: 10.1111/j.1533-2500.2012.00565.x
Staats PS, Chafin TB, Golovac S, Kim CK, Li S, Richardson WB, Vallejo R, Wahezi SE, Washabaugh EP, 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;43:789-794.