Minimally Invasive Lumbar Decompression (MILD Procedure)
The MILD procedure is a minimally invasive procedure that decompresses the central spinal canal or tunnel through which the spinal cord or its individual nerves run from the brain downward. The procedure can relieve the pressure that the traversing nerves have from being crowded by the posterior longitudinal ligament which runs along the posterior or back side of the central spinal canal. Frequently, symptoms of spinal stenosis can be relieved with the increased room in the canal which occurs when the ligament is thinned by the MILD procedure. This can result in a more upright position, improved walking and standing endurance, and reduced back pain. It does prevent other treatment options to be done in the future.
Candidates for MILD
Patients who have symptoms of lumbar spinal stenosis are candidates for the MILD procedure. The symptoms are back pain, leg pain, and/or leg fatigue when standing or walking and relief of these symptoms when sitting or leaning forward as on a grocery cart. Most insurance companies require that the patient fail to improve pain and function with epidural steroid injections, physical therapy, and medication therapy such as NSAIDs, gabapentin, or tricyclic antidepressants. MILD cannot be done optimally if a patient has a radiographic contrast or dye allergy, has had extensive spine surgery that have disturbed the boney landmarks used in the procedure, or if anticoagulation cannot be stopped temporarily. Medicare plans including advantage plans, VA, US Military and HIS cover the MILD procedure; commercial insurance coverage varies and would have to be pre-approved which PCI does for all patients if available.
The MILD Procedure
The MILD procedure is done in the outpatient surgery department of the hospital. It is generally performed under local anesthesia and mild sedation provided by the anesthetist. The MILD procedure takes about 1 hour to perform and most return home shortly after completion with full activities without restrictions allowed in 24 hours. The tools used are disposable and not reused; they FDA approved for the procedure. The procedure is done through small incisions that are about the size of a baby aspirin in diameter. Steroids are not typically administered during the procedure and no stitches are left afterward to remove.
Risks of MILD Procedure
The complications from the MILD procedure are low frequency and similar to an epidural steroid injection. With most surgical procedures, serious adverse events, some of which can be fatal, can occur including heart attack, cardiac arrest, allergic reaction to medication during surgery, stroke, and embolism or blood clots to the lung. Other risks include infection and bleeding, spinal cord and nerve injury that can, in rare instances, cause paralysis. The procedure is not for everyone but PCI providers will thoroughly discuss the risks, upsides and downsides in a comprehensive way so you can make an informed decision with the best information available.