The Minimally Invasive Lumbar Decompression (MILD) Procedure for Lumbar Spinal Stenosis

The Institute of Medicine came out with some alarming statistics recently. They showed that over one third of the United States deals with chronic pain at a cost of over $500 billion annually. This becomes a major factor in physician office visits and also because of disability and lost time from work.

The most common reason that patients over the age of 65 undergo spinal surgery procedures is due to lumbar spinal stenosis. As we move into an ever increasing cutting-edge modern age of medical technology, forging ahead with minimally invasive surgical techniques will save patients significant risks of surgery and hopefully lead to quicker better outcomes.

For lumbar spinal stenosis one of these emerging technologies is MILD, which is short for minimally invasive lumbar decompression. This procedure is meant to be minimally invasive while at the same time offering a durable option for reducing pain and increasing mobility by bringing back space in the spinal canal while maintaining structural anatomic stability.

The gold standard for lumbar spinal stenosis in surgery is a decompression procedure. This may be a laminectomy, or it may be a laminotomy which involves taking away less bone and therefore contributing less to instability. Over the years there have been numerous attempts to try and introduce minimally invasive options for lumbar decompression.

With this new minimally invasive procedure patients do not need implants put in and there is less postoperative pain, and the recovery time is more rapid. The innovative procedure can be done under local anesthesia with some conscious sedation and general anesthesia is not necessary. The area in the epidural space is visualized utilizing fluoroscopy and instruments are used to take away some of the large soft tissue that has overgrown in the spinal canal.

This procedure is a less invasive option that has a fairly low risk profile. No long-term large studies have been performed to date utilizing the MILD procedure. It remains to be seen if it shows superiority compared to the current gold standard which as mentioned is a simple laminectomy.

With a laminectomy or a laminotomy, patients are often able to go home the same day or the following day. Typically the patients are a bit older so keeping them overnight is often prudent. A lot of patients who undergo a laminectomy end up with back stiffness or pain postoperatively. Research shows this incidence to be at 50%. Potentially the MILD procedure will cause less back pain and stiffness postoperatively. This remains to be seen.