scholarly journals Retrospective Review of Patient Self-Reported Improvement and Post-Procedure Findings for mild® (Minimally Invasive Lumbar Decompression)

2010 ◽  
Vol 6;13 (6;12) ◽  
pp. 555-560
Author(s):  
Jay S Grider
Keyword(s):  
Adverse Events ◽  
Minimally Invasive ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Ligamentum Flavum ◽  
Neurogenic Claudication ◽  
Lumbar Decompression ◽  
Post Procedure ◽  
Lumbar Spinal ◽  
Major Adverse Events

Background: Lumbar spinal stenosis and neurogenic claudication functionally impact thousands of patients per year. Those who fail conservative therapies and are not surgical candidates due to co-morbid conditions have few interventional options available. The recently described mild® procedure (Minimally Invasive Lumbar Decompression) is a candidate to fill this void. While 2 studies have reported no major adverse events with this procedure, the typical post-procedure patient course has not been previously described. Objective: To examine the minor adverse events and periprocedural course associated with mild. Additionally, to evaluate the efficacy of the procedure with regard to pain relief and functional status. Design: Retrospective evaluation. Methods: Forty-two consecutive patients meeting magnetic resonance imaging (MRI) criteria for mild underwent the procedure performed by 2 interventional pain management physicians working at the same center. The pre and post procedure visual analog scale (VAS) as well as markers of global function were recorded. Major and minor adverse events were tracked and patient outcomes reported. Results: There were no major adverse events reported. Of the minor adverse events, soreness lasting 3.8 days was most frequently reported. No patients required overnight observation and only 5 required postoperative opioid analgesics. Patients self-reported improvement in function as assessed by ability to stand and ambulate for greater than 15 minutes, whereas prior to the procedure 98% reported significant limitations in these markers of global functioning. Visual analog pain scores were significantly decreased by 40% from baseline. Eighty-six percent of the patients reported that they would recommend the mild procedure to others. Conclusions: The mild procedure appears to be a safe and likely effective option for treatment of neruogenic claudication in patients who have failed conservative therapy and have ligamentum flavum hypertrophy as the primary distinguishing component of the stenosis. Key words: Minimally invasive lumbar decompression, lumbar spinal stenosis, neurogenic claudication, fluoroscopy, ligamentum flavum

scholarly journals Minimally invasive lumbar decompression: a review of indications, techniques, efficacy and safety

2020 ◽  
Vol 10 (5) ◽  
pp. 331-348 ◽  
Author(s):  
Sameer Jain ◽  
Timothy Deer ◽  
Dawood Sayed ◽  
Pooja Chopra ◽  
Sayed Wahezi ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Treatment Guidelines ◽  
Treatment Algorithm ◽  
Neurogenic Claudication ◽  
Efficacy And Safety ◽  
Safety And Efficacy ◽  
Lumbar Decompression ◽  
Lumbar Spinal

Lumbar spinal stenosis is a common degenerative spine condition. In properly selected patients, minimally invasive lumbar decompression ( mild®) may be an option to improve outcomes. This review provides an in-depth description of the mild procedure and a comprehensive examination of safety and efficacy. Two randomized controlled trials, together with 11 other controlled clinical studies, have established the efficacy of mild, which is a minimally invasive procedure that does not involve implants and has demonstrated excellent efficacy and safety. With an established safety profile equivalent to epidural steroid injections, and efficacy that has been shown to be superior to such injections, mild can reasonably be positioned early in the treatment algorithm for these patients. Based on extensive review of the literature, robust safety and efficacy through 2 years, and in accordance with minimally invasive spine treatment guidelines, mild is recommended as the first intervention after failure of conservative measures for lumbar spinal stenosis patients with neurogenic claudication and ligamentum flavum hypertrophy.

scholarly journals Study of Percutaneous Lumbar Decompression and Treatment Algorithm for Patients Suffering from Neurogenic Claudication

2012 ◽  
Vol 6;15 (6;12) ◽  
pp. 451-460
Author(s):  
Timothy R. Deer
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Radicular Pain ◽  
Neurogenic Claudication ◽  
Lumbar Decompression ◽  
Reduction Of Pain ◽  
One Year ◽  
Lumbar Spinal ◽  
Over Time

Background: Symptomatic lumbar spinal stenosis (LSS) patients often suffer from multiple etiologies, and patient symptoms must be differentiated and identified as either neurogenic claudication, radicular pain, or both. The most common symptom associated with LSS is neurogenic claudication, which has been reported to occur in 91% to 100% of the LSS patient population. Neurogenic claudication symptoms are described as pain radiating to the lower extremities that begins and worsens as the patient ambulates. Neurogenic claudication symptoms worsen over time and can eventually result in significant life-altering functional limitations. Symptomatic LSS patients may also suffer from radicular pain, which is a persistent pain transmitted through neural pathways, and is associated with inflammation of the exiting nerve root. Objective: To assess patient safety, pain reduction, and functional status of patients treated with percutaneous lumbar decompression. Study Design: Single-center, prospective clinical study of 46 consecutive patients with neurogenic claudication symptoms related to lumbar spinal stenosis. Setting: US interventional pain management practice. Methods: From March 2010 to January 2011, 46 LSS patients suffering from neurogenic claudication underwent mild percutaneous lumbar decompression. Of these, 12-week, 6-month and one-year followup was available for 35 patients. Outcome Assessment: Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and Zurich Claudication Questionnaire (ZCQ). Outcomes were assessed at baseline, 12-week, 6-month and one-year follow-up. Results: One-year follow-up patients in this study experienced statistically and clinically significant improvement in physical function, as well as reduction of pain intensity. The initial improvement in these patients, which was significant, was sustained through one year, with no significant differences among the interim follow-up visit periods. These results demonstrate early improvement following treatment with a high degree of durability over time. There were no serious device or procedure-related complications reported in this study. Limitations: Single-center study with no control group. Conclusions: In this study, the mild procedure was shown to be safe. In addition, patients experienced significant improvement in mobility and reduction of pain one year after the procedure. One-year outcomes were not significantly different from interim results, indicating that the significant improvement following treatment, occurring as early as 12 weeks, was maintained through one year. This high degree of consistency over time indicates the durability of percutaneous lumbar decompression in the treatment of neurogenic claudication in symptomatic LSS. Key words: Spine, lumbar, lumbar spinal stenosis, neurogenic claudication, decompression, ligamentum flavum, mild, percutaneous.

Facetoplasty Using Radiofrequency Thermocoagulation for Facet Joint Hypertrophy

2016 ◽  
Vol 4;19 (4;5) ◽  
pp. E649-E652
Author(s):  
Daehyun Jo
Keyword(s):  
Minimally Invasive ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Facet Joint ◽  
Definitive Treatment ◽  
Neurogenic Claudication ◽  
Interventional Treatment ◽  
Low Back ◽  
Radiofrequency Thermocoagulation ◽  
Lumbar Spinal

Lumbar spinal stenosis is one of most common pathologic conditions affecting the lumbar spine. Pain and/or disability in the low back and lower extremities with or without neurogenic claudication may occur as a result of compression of dural sac contents or nerve roots in the narrowed space. Bulging and protrusion, facet joint hypertrophy, and disc herniation combined with osteophytes and arthritic changes of facet joints can be the cause of lumbar spinal stenosis. Medical/interventional treatment may be considered as an initial treatment for patients with mild symptoms of lumbar spinal stenosis. Surgery is usually considered when medical/interventional treatment has failed. Even though surgery has been considered to be the definitive treatment for spinal stenosis conventionally, it has potential problems including general anesthesia related complications and failed back surgery syndrome. For that reason, minimally invasive techniques such as percutaneous endoscopic lumbar discectomy (PELD), epiduroscopic laser neural decompression (ELND), and nucleoplasty with radiofrequency have been developed as alternatives to surgery. The authors present a case of treating lumbar spinal stenosis by using radiofrequency thermocoagulation. Radiofrequency therapy is used for spinal pain, usually in forms of neurotomy or nucleoplasty. The patient in this case had leg pain with neurogenic claudication caused by lumbar spinal stenosis from facet joint hypertrophy. His pain did not respond to conservative treatment including epidural steroid injection, but he didn’t want to get surgery. As an alternative to surgery, we applied radiofrequency thermocoagulation with high temperatures of electrode to the hypertrophied facet joint for the decompressing of the spinal nerve and the patient’s pain was improved without any complications after the treatment. Key words: Low back pain, neurogenic claudication, lumbar spinal stenosis, facet joint hypertrophy, radiofrequency thermocoagulation, minimally invasive technique

scholarly journals The Impact of Age on the Outcomes of Minimally Invasive Lumbar Decompression for Lumbar Spinal Stenosis

2020 ◽  
Vol Volume 13 ◽  
pp. 151-161
Author(s):  
Nagy A Mekhail ◽  
Shrif J Costandi ◽  
Sherif Armanyous ◽  
Ricardo Vallejo ◽  
Lawrence R Poree ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Lumbar Decompression ◽  
Lumbar Spinal ◽  
The Impact
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