MILD – Minimally Invasive Lumbar Decompression

The mild procedure is a new, minimally invasive treatment option to reduce pain and improve mobility in LSS patients. - Dr. Johnson

Many of you with lumbar stenosis (narrow lumbar spinal canal) have had this one hour outpatient operation done by me and have volunteered to be available to others considering it. Thank you all.

Having done more of this operation than anyone on the West Coast (over 350), and seeing the remarkable benefit it has been to so many, it’s clear that an update is due.

The MILD is used to treat Lumbar spinal stenosis

Lumbar stenosis is a common problem in the over-60-year-olds because our spinal canals narrow through life and can get so tight that the nerve roots are squeezed. When we stand up straight our spinal canals get slightly narrower so folks with Lumbar Stenosis avoid standing up straight. Their pain comes on with standing or walking too long and is relieved with stooping and sitting down. This is different from Sciatica which is a discrete shooting pain like a stripe down the leg. In Lumbar Stenosis the pain in the back refers into the legs and is accompanied by a heavy, clumsy, or weak feeling. Traditionally it had been treated with an open surgery to cut out ligament and bone that is crowding the nerves from the back side of the canal. The risks and costs of traditional surgery has repelled many people who continue to lose quality of life as they spend more and more time sitting. The MILD procedure can change that for many.

MILD is done using a probe that is the approximate size of a pencil. Miniature instruments are used under 3D fluoroscopic guidance to shave the thick ligament from the back thereby relieving the nerves. Since it’s done from the back side, the vital structures such as arteries and nerves are avoided. Since the puncture is just 5mm, there is no need for suture. A Band-Aid is sufficient. No hardware is implanted because there is no disruption of the spine’s stability. It usually takes about an hour with no overnight stay, and you’re able to resume regular activity by the next day.

The MiDAS 1 study was a forward looking expert-reviewed study published in Pain Practice Journal in June. Many of you participated with me in this study and contributed substantially to our knowledge, thank you. This is a nationwide study that showed the benefit of improved standing and walking and reduced pain continued for the one year follow-up time in about 70% of cases. There were no complications! Over 19 research articles have been published and many more research projects continue on MILD.

Dr. Johnson about to perform the MILD.

It is one of the hottest topics in spine medicine right now because over 8,000 cases have been tracked nationwide. Having taught over 300 of the 700+ doctors certified to do this procedure and presented at the American Academy of Pain Medicine and other conferences, I’m pleased with the quality of research coming out and eager for the message to get out.

If you or someone you care about is having back pain with decreasing ability to stand and walk, this may be an option for you. Call us at the University Spine Institute for an appointment.


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