Minimally Invasive Lumbar Decompression for Back Pain
mild is an acronym for Minimally Invasive Lumbar Decompression, and it’s used to treat patients with back pain caused by central spinal stenosis. Spinal stenosis is a phenomenon where you get narrowing of the canal that the spinal cord goes through. For the mild procedure, we’re specifically looking at thickening of a tissue called the ligamentum flavum, which is Latin for the “yellow ligament.” For lots of reasons when we get older, that ligament will shorten and thicken. As it thickens, it causes an encroachment or a narrowing at the level around the spinal cord.
The mild procedure’s job is to go in and debulk or take out some of the extra tissue inside of the ligamentum flavum. We don’t take out the ligamentum flavum, we don’t remove the supportive fibers of the ligamentum flavum, we don’t remove bone, we don’t remove ligament other than the parts of tissue from the ligamentum flavum, and we don’t remove any disc. This procedure is done very often by myself and my staff. As a whole, it’s a relatively very safe procedure compared to a larger spine surgery for someone with mild to moderate stenosis.
There have been multiple non-surgical treatment options for spinal stenosis. They start with physical therapy, which has a pretty good track record. They go next to medications, be it things like acetaminophen or Tylenol, Advil or Aleve, and even medicines like hydrocodone or morphine. All those medicines have their own positives or negatives. Other treatment options include epidural steroid injections. Everyone’s pretty familiar with those. We inject steroid in the epidural space, the area around the nerves in the low back, and injections do have pretty good results, but usually they’re self-limiting. They usually last 3-6 months. Sometimes we’ve done them for several months at a time and they no longer have any benefit in pain reduction. Usually the next step then is surgery. With surgery, it usually requires a three-day hospital stay, and that’s one of the biggest downfalls of surgery. But when you have severe stenosis, even moderate to severe stenosis, surgery is the absolute correct treatment.
The ideal candidate for the mild procedure is someone who has central stenosis. In other words, bulging in that ligamentum flavum inside the middle of the spinal cord as opposed to off to the sides. It’s also somebody who has mild to moderate stenosis. Meaning, when we look at the MRI on somebody, it’s not completely cutting off the spinal cord. People with severe stenosis need to see a spine surgeon. People who have mild to moderate stenosis, patients who don’t personally feel like they’re ready for surgery, or the surgeon might feel they’re not ready for surgery, or they might not be well enough for surgery, are ideal candidates.