MILD Procedure
MILD (minimally invasive lumbar decompression) is an outpatient procedure that lasts less than one hour and requires no general anesthesia, implants or stitches. The process is performed through a tiny incision in the lower back and involves removing small fragments of bone and excess ligament tissue to restore space in the spinal canal and decrease the compression of nerves. Clinical studies show that 79 percent of patients who underwent the MILD procedure experienced a 53 percent reduction in pain and a 34 percent increase in mobility within a year.
With this procedure, needle-like instruments are used to remove a portion of a thickened ligament in the back of the spinal column to increase spinal canal space and remove nerve root impingement. Only patients with lumbar spinal stenosis and a thickened ligament are eligible for this type of decompression.
The procedure is called percutaneous image-guided lumbar decompression (PILD) or is more commonly known as the minimally invasive lumbar decompression (MILD). Because MILD is performed without general anesthesia, it may be an option for some people with high surgical risks from other medical problems and is considered a safer alternative for some patients.
At Aptiva Health, we offer same-day and walk-in appointments for spine injuries and conditions to evaluate, diagnose, and make the appropriate referral for additional treatment based upon your specific spine injury or condition. We treat spine injuries and conditions in our Spine, Pain Management, General Medicine, Orthopedics, and Physical Therapy departments.
Surgical Indications
This procedure is performed by the Aptiva Health pain management team for patients with severe lumbar spinal stenosis. Lumbar spinal stenosis can be caused by bulging discs or hypertrophy of the ligamentum flavum. When disc bulging occurs in the lumbar spine it can cause narrowing of the spinal canal, which results in nerve compression.
Patients that are experiencing symptoms related to lumbar spinal stenosis will notice increased pain and symptoms with standing or walking. This increase pain occurs because when someone with lumbar spinal stenosis stand or walks, the spinal canal narrows even more, causing low back and leg pain that is relieved with sitting or bending forward, which is called neurogenic claudication.
The MILD procedure is a potential indication once a patient has exhausted conservative measures and injections therapy to manage their pain and symptoms associated with lumbar spinal stenosis. Once these treatment options have been exhausted, your pain management doctor at Aptiva Health will counsel you on the benefits, risks, and alternatives associated with the MILD procedure.
Description of Procedure
The MILD procedure is typically performed without general anesthesia. Your pain management doctor will begin the procedure while you are under deep sedation with a small 1-cm incision. The doctor will use a special sculpting tool that glides through a portal with a diameter of 5 mm (comparable to the size of a pen cap) to navigate between the bones. Your doctor will then use this instrument to scrape out the ligament and widen the spinal canal to reduce nerve roots compression. Contrast material is injected into the epidural space to assess positioning and guide with visualization throughout the procedure.
One of several benefits of this procedure is that the patients vertebrae are not disturbed. Because the bony architecture of the spine remains intact, spinal mechanics are not disrupted and patients typically recover quickly. After the procedure, you will be discharged home after a few hours and will be able to begin the rehabilitation program. Patients are encouraged to walk regularly and/or participate in physical therapy following the procedure.