Background & Aims
Chronic low back pain (CLBP) is a leading cause of disability-adjusted life years. A common cause of CLBP is lumbar spinal stenosis, which accounts for 85% of cases due to ligamentum flavum hypertrophy (LFH). Symptoms include low back pain, radiculopathy, neurogenic claudication, and weakness. Minimally Invasive Lumbar Decompression (MILD) is a procedure that decompresses the spinal cord by removing a portion of the bone or the ligamentum flavum. Recent studies have demonstrated the MILD procedure to be safe and as effective as epidural steroid injections (ESI)1. The objective of this study is to determine the efficacy of the MILD procedure in improving pain levels and functional status of patients with chronic back pain.
Methods
This is an IRB-approved retrospective study of patients who underwent the MILD procedure from Jan-Dec 2023, had LFH measuring >2.5mm on MRI and exhibited symptoms of lumbar stenosis . Patients underwent a telephone interviewed after the completion of their surgery and were asked questions related to their pain and functional status before surgery and 1 month after surgery. The surgery was performed under live fluoroscopic imaging. A small 5.1 mm incision was created through in which a bone rongeur was advanced to remove any obstruction caused by osteophyte growth. A tissue sculpture was then advanced to debulk the ligamentum flavum.
Results
A total of 4 patients were consented and agreed to participate in the study. Using a standardized quality of life score on average patients had a better quality of life 1 month after surgery compared to pre-op [ 6 (SD +/- 2.7) vs 3.25 (SD +/- 0.5)] with a higher number correlating to better functioning status. Patients reported better pain control after their surgery compared to prior [2.75 (+/- 0.96) vs intensity score of 5 (SD +/- 0.82)] with lower scores indicating lower pain intensity. All patients underwent the procedure without any complications related to the surgery or device.
Conclusions
The results of our study indicate that the MILD procedure is an effective treatment option for patients with lumbar spinal stenosis who have failed conservative treatment with ESI. Given the minimally invasive nature of surgery and low risk of complications, we suggest considering MILD surgery earlier during treatment protocol, to help achieve functional improvement and better quality of life. A prospective longitudinal study is needed to determine the duration of symptom improvement and outcomes related to this treatment.
References
Jain S, Deer T, Sayed D, Chopra P, Wahezi S, Jassal N, Weisbein J, Jameson J, Malinowski M, Golovac S. Minimally invasive lumbar decompression: a review of indications, techniques, efficacy and safety. Pain Management. 2020 Sep;10(5):331-48.
Tredway TL. Minimally invasive lumbar decompression. Neurosurgery Clinics. 2006 Oct 1;17(4):467-76.
Presenting Author
Nancy Abarca
Poster Authors
Topics
- Treatment/Management: Interventional Therapies – Minor surgical procedures