The mild procedure is a new minimally invasive treatment option to reduce pain and improve mobility for our patients with Lumbar Spinal Stenosis (LSS).

To understand how the mild procedure can help LSS patients, one must first understand what LSS is:
Your spine provides support for your back and body. It also protects the spinal cord, the bundle of nerve tissues that runs from your brain to your lower body. The bony channel that encloses the spinal cord is called the spinal canal. Usually, there is enough space between the spinal cord and the spinal canal so the nerves that flow through and exit the spinal canal are free of obstruction.

As your body ages, however, the ligaments and bones outside the spinal canal may thicken and begin to press on the spinal canal, causing it to narrow. This narrowing of the spinal canal is called spinal stenosis. In fact, stenosis is a Greek word that means choking, which describes what happens to the spinal cord. When stenosis occurs in the lower part of the spine, it’s called lumbar spinal stenosis. This narrowing of the canal can compress or pinch nerve tissues, resulting in pain, numbness and limited mobility.

Images of Spinal Stenosis

It is “ Minimally Invasive” because minimal tissue trauma occurs during surgery, and the structural integrity of the spinal column is not compromised. In fact, trauma and post-op pain is so minimal compared to typical spinal surgery, that it is performed under local anesthesia with IV sedation (not general anesthesia) as an out-patient surgery. To date, the post-operative complication rate appears to be no greater than those of other minimally invasive spinal procedures such as epidural steroid injections or nerve root injections.


It is a “ Lumbar Decompression” because the purpose of the surgery is tode-bulk the grossly swollen Ligamentum Flavum (the ligament that runsalong the back side of the spinal canal between the laminar bones) whichis one of the primary causes of compression on the spinal canal, therebyremoving compression, or “decompressing” the lumbar spine. This leadsto reduced pressure on the spinal nerves, and improved blood flow in thespinal canal that translates to reduction or elimination of pain.


How is it performed? After placing the patient on their stomach, a live, continuous-camera X-ray machine (called a Fluoroscope) is used to guide the surgeon throughout the procedure. After identifying the level of the spine where the stenosis is present, a dye contrast study is performed (called an epidurogram) that shows the boundaries of the Ligamentum Flavum. A very small incision is then used to pass a trochar (a tube the size of a pencil used to pass the other instruments through) to the laminar bone. A small amount of bone is then removed (called a Laminotomy) to allow passage of the tissue-sculpting instrument that de-bulks the Ligamentum Flavum. The entire ligament is not removed, leaving the front fibers intact so the stability of the spine is not compromised. If more than one side or level is to be decompressed, then the process is repeated until all planned levels are completed. The small incision (or incisions) are then typically closed with steri-strips or a bonding agent with no sutures involved.


Who is a candidate for the MILD procedure? Anyone who has Lumbar Spinal Stenosis, where one of the primary causes of the canal compression is due to a thickened Ligamentum Flavum, compressing the back side of the Spinal Canal. If there is excessive compression of the Spinal Canal from the outer sides or front side of the canal, as seen at times with advanced arthritis or herniated discs, then you would likely not be a candidate. Those that respond best, are those who have back and leg pain that occurs primarily with standing and walking, but is relieved with sitting.

http://www.vertosmed.com/physician/mild_procedure_anim.php

http://physician.vertosmed.com/patient-education.asp

English mild procedure brochure PDF File

Spanish mild procedure brochure PDF File

FAQs

Unlike some treatments that may only temporarily address symptoms, mild is a minimally invasive procedure that addresses the underlying cause of pain and immobility in patients with LSS. Compared to more invasive surgical decompression procedures that require general anesthesia, mild can be performed in an outpatient setting under local anesthesia. Also, procedure and recovery times are generally reduced compared to more invasive procedures, after which patients may need rehabilitation or physical therapy.