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O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E | F E B R U A R Y 2 0 1 4
N E U R O S U R G E R Y
NO-STITCH SPINE SURGERY
A Primer on Minimally Invasive Lumbar Decompression
O
ne of the most common degenerative diseases of aging
patients is lumbar spinal stenosis (LSS). It can cause debilitat-
ing pain and decreased function. But now a safe, effective,
cost-efficient and minimally invasive outpatient procedure for LSS has
been approved for ambulatory surgery centers by CMS — minimally
invasive lumbar decompression, also known as MILD.
More than 1.2 million patients in the United States have been treated
for LSS, and that number is bound to rise as the population ages. There
was a time when all I could offer them was short-term palliative medical
management. But if symptoms persisted or worsened, I referred them out
for invasive inpatient decompression procedures. Not anymore.
The MILD procedure involves using fluoroscopic imaging to guide
resection of the thickened ligamentum flavum through a 5.1mm treatment
portal. There's minimal tissue disruption and structural stability is main-
tained. No general anesthesia or implants are required. To achieve
decompression of the spinal nerves, the surgeon removes small amounts
of bone and hypertrophic ligamentum flavum under local anesthesia and
light sedation. The epidurogram is the most invasive part, because fluoro-
scopic visualization is used throughout, and all devices stay posterior to
the dura.
The contrast flow improvement in the epidurogram shows when suffi-
cient decompression of the space is achieved. Then the devices are
removed, and the incision is closed with a Steri-Strip. You don't even need
stitches.
Treatment can be performed at single or multiple levels, unilaterally or
bilaterally. Each procedure takes about 30 to 60 minutes, and patients
remain in recovery for 1 to 2 hours. No special follow-up care is needed.
They typically walk out and resume light activities within a few days.
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