MILD is a relatively new procedure for patients with spinal stenosis due to ligamentum flavum hypertrophy (LFH). This may be offered in place of the higher risk procedures such as an open laminectomy, interspinous process distraction devices, and fusions. The typical patient has neurogenic claudication symptoms with pain, tingling and numbness in the lower back, legs or buttocks that worsen with lumbar extension (standing or walking). Patients will often describe improvement of their symptoms while bending forward, sitting or lying down. MRI will reveal thickening of the ligamentum flavum, >2.5 mm and often times >4 mm. Commonly these patients’ MRI will also show bulging discs, facet hypertrophy, osteophytes, scoliosis and other such degenerative issues within the spine. Despite this patients still show improvement with the MILD procedure.
The MILD procedure is a safe, outpatient, fluoroscopically guided therapeutic treatment. The procedure is performed through a 5.1 mm treatment portal that requires no general anesthesia, no implants, and no stitches. We remove not only small portions of the hypertrophic ligamentum flavum, but also small portions of the lamina leaving the spine structurally intact.
The MILD procedure has a safety profile equivalent to that of doing an epidural steroid injection. There were no major device related complications reported in any of the clinical trials. The adverse event rate is less than 0.1% in more than 20,000 commercial cases.
The research has demonstrated approximately 80% of patients will have a significant reduction in pain, increased standing time and walking distance. Cleveland Clinic prospective study showed improvement in function, walking distance and standing time that remained at 1 year.
If you have LFH associated with your spinal stenosis, we recommend the MILD procedure prior to considering Vertiflex, Minuteman or an open invasive surgery. With the MILD there is not a device placed in your spine and no stitches are needed. If you happen to not do well with the MILD procedure, you can still consider the above mentioned procedures. To learn more about the MILD procedure go to www.mildprocedure.com