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Millions of people in the US suffers from lumbar stenosis. You may encounter them at the grocery store leaning on their grocery cart so that they can finish their shopping or at the local mail sitting on a bench to wait for their left to start functioning properly again. These people all have one thing in common: they suffer from lumbar stenosis (LSS). What is lumbar stenosis? It is a medical condition in which the lower spinal canal narrows and compresses the spinal nerves in the low back. It is often brought on by activities such as standing for any length of time which compresses the spinal nerves that form the sciatic nerves. It is best visualized as a “kink in drinking straw”. Typically, patients affected with LSS can experience any of the following symptoms:

  • Numbness or tingling in the foot or leg.
  • Weakness and stiffness in the leg, buttock, and feet
  • Pain or cramps in one or both legs when standing for long periods or when walking.
  • Lower back, hip, and buttock pain

What causes LSS?

As we age the diameter of our spinal canal typically diminishes due to a combination of factors such thickening of the spinal ligaments, disc bulging and bony overgrowth from arthritis of the lumbar spinal joints. LSS is one of the most common spinal disorders especially in individuals over 50. As a result of the narrowing of the spinal canal, the spinal nerves will become compressed within the spinal canal leading to typical symptoms of LSS. Early on with LSS, the symptoms will only manifest themselves during certain activities such as standing, walking, arching of the low back, lifting and the relief is usually obtained with leaning forward (“The shopping cart syndrome”) or by sitting and laying down. Unfortunately, as the condition of the spine worsens these symptoms will often become more intense and more constant thus severely affecting the activity level of patients with LSS.

Treatments for LSS

Fortunately, there are several treatment options to help with LSS. Early in the course of the disease lumbar epidural steroid injections can be effective at relieving the symptoms by decreasing the inflammation within the spinal canal. However, when the epidurals are no longer effective or if the relief does not las then other treatments to “physically” create space within the spinal canal should be considered. Such options are the MILD procedure, Superion, and surgical laminectomy.

How does the MILD procedure work?

The MILD procedure works for removing or the ligament flavum which often become enlarged as we get older. The ligament flavum is one of the main causes of LSS. Through a very small incision (the size of a baby aspirin) which requires no stitches a special needle is advanced to the ligamentum flavum which is then shaved down to reduce the thickness of the ligament thus creating more space for the spinal nerves to run through the spinal canal. The MILD procedure can be used any segment of the lumbar spine.

Is the MILD procedure effective?

The MILD procedure is very effective for the appropriate person meaning that if you are experiencing LSS symptoms caused by enlargement of the ligamentum flavum then you might be a great candidate for the MILD procedure. In fact, studies show that 79% of patients experience a significant reduction in pain and significant increase in function and mobility. The Cleveland 1-year clinic study showed that patients “could increase their average standing time from 8 minutes to 56 minutes, their average walking distance from 246 to 3,956 feet (a 16x increase) while the “MIDAS ENCORE 2- year study: mild demonstrated excellent durability and continued improvement in patient functionality, including increased mobility and reduction of pain.”

How safe is the MILD procedure?

The MILD procedure has been proven to be a safe procedure with a very low risk of major complication. The procedure is performed through a very small incision which requires no stitches, no implant, and no general anesthesia. It is a short procedure usually performed under 45 minutes which is performed on an outpatient basis. This procedure has been offered to thousands of patients in the US since 2005. The procedure can be performed local anesthesia and/or light sedation. Most patient can resume all activities within 24 hours. “Complication rate <0.1% in more than 30,000 commercial cases. No device or procedure-related serious complications reported in any clinical trial.”

Why should you choose MILD over lumbar surgery for LSS?

While both procedures can be effective at relieving the symptoms of lumbar stenosis, they are quite different procedures. First, the MILD procedure is done under light sedation or just local anesthetics. The MILD procedure also does not involve removing bones from the spine, thus not creating any sort of instability in the spine. It is also quicker recovery as the patients can return to their full activities within 24 hours. The MILD procedure also does prevent patients from receiving other treatments, such as Superion or spine surgery later if needed.

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