Most adults experience lower back pain at some point, which can be devastating. Lower back pain can lead to job-associated disabilities, causing you to miss work due to discomfort. Lower back pain has several potential causes, but it commonly results from lumbar spinal stenosis (LSS). If you suffer from lumbar spinal stenosis, you can benefit from minimally invasive lumbar decompression (MILD). At Dr. George Rappard’s practice in Los Angeles, we treat chronic lower back pain, particularly for people suffering from LSS. We use MILD to relieve pain, manage your condition, and improve your overall quality of life.
The Origin Of Minimally Invasive Decompression (MILD) Procedure
Dr. Donald Schomer and Dr. David Solsberg developed the procedure in 2005. They invented this procedure to assist in treating cancer patients with spinal stenosis who could not tolerate spine surgery due to comorbidities. Initially, the decompression was known as the X-Sten MILD Tool Kit. It secured a 510(k) clearance from the US Food and Drug Administration (FDA) on December 19, 2006.
After FDA clearance, the first patient was treated immediately. Twelve clinical studies were completed within a few years of MILD's introduction, which showed the procedure's efficacy. In 2016, MiDAS ENCORE carried out a one-year randomized control trial. The results later showed that MILD was statistically robust to ESIs in treating select patients with LSS. In 2017, the US Center for Medicare and Medicaid Services supported nationwide Medicare coverage of MILD following the publication of level 1 evidence.
Anatomy Of The Spine
The human body has 206 bones, including the spine, which significantly supports the rest of the body. The spine also cushions the spinal cord from injury and damage.
The spine is composed of 33 stacked bones known as vertebrae. The vertebrae form the primary skeletal frame known as the spinal column. The spine is curved in an S shape. The curve acts as a coiled slinky or spring that absorbs shock, helping the body maintain range of motion and balance.
The spinal column has the following parts:
The spinal cord is located in the neck and plays a vital role because it sends messages from the brain to other body parts. The messages go to various body parts to carry out specific voluntary and involuntary actions. The spinal cord also allows you to freely and flexibly move your neck in any direction.
Mid Back (Thoracic)
The mid-upper back is the middle part of the spinal column or thoracic region. It is responsible for keeping the body upright, providing stability, and protecting the lungs and heart.
Lower Back (Lumbar)
The lower back is the lumbar region of the spinal column. The lower back supports and cushions the nerves and spinal cord against injury.
A healthy spine has solid and flexible ligaments, tendons, nerves, and muscles that allow you to turn, bend, sit, and stand upright.
You can experience chronic or severe pain if disease, injury, or strain affects these structures.
Causes and Types of Lower Back Pain
The structure of your spine can change with every injury to the neck or back. Lower back pain could arise from an injury, a fall, lifting a heavy load, or an accident. Pain could also be due to the following factors:
- Having a sedentary lifestyle.
- Being overweight.
Sitting for a long time, particularly at work, without exercise can cause lower back pain. Both men and women can suffer lower back pain. Lower back pain has intensity levels ranging from sudden to dull and persistent. It can be severe, leaving you incapacitated for a while.
Acute Lower Back Pain
Lower back pain, at times, can be short-term or acute, meaning it can take a few days or weeks. Acute lower back pain arises because of how the nerves, intervertebral discs, and muscles move and work together.
The solution for acute pain includes:
- Participating in low-intensity exercises to strengthen the back muscles.
- Physical therapy.
- Medication, and.
Chronic Lower Back Pain
Chronic back pain is common in the lumbar region of the spine. Chronic back pain is persistent and takes twelve weeks or more. It can come back even after treatment. Doctors claim that one in five patients with acute lower back pain has signs of chronic back pain lasting up to one year.
The typical treatments for chronic lower back pain include:
- Surgical treatment.
- Extensive physical therapy.
Lumbar Spinal Stenosis
Common back problems affecting the lower back or lumbar region are caused by spine formation and part problems. The structure of the spine and the associated parts make it mechanical. This leads to normal wear and tear. It also leads to disc, joint, and bone degeneration as you age.
Lumbar spinal stenosis (LSS) is the most common cause of lower back pain. LSS is typically a condition that affects the lower part of the spine. If you have lumbar spinal stenosis, you could experience chronic back pain as your spinal column narrows. The narrow spinal column exerts pressure on the nerves and spinal cord, leading to numbness and pain in the legs and lower back area. After some time, walking and moving can be challenging, causing sensory loss and weakness in the legs. The following are other conditions that can affect the lower back:
- Strains and sprains.
- Herniated or ruptured discs.
- Intervertebral disc degeneration.
Minimally Invasive Lumbar Decompression (MILD)
Conventional treatments for lumbar pain include medications, physical therapy, strengthening exercises, heat, and ice. If you have chronic pain, your treatment method can be more invasive. If your diagnostic tests reveal reprehensible nerve damage and structural changes in the spine, your doctor could even recommend surgical intervention.
A proven treatment for lumbar spinal stenosis is minimally invasive decompression. You could suffer from lumbar spinal stenosis if you experience severe pain after walking or standing for a short time. Since technology and medical procedures have advanced, treatment procedures have become less invasive.
Currently, conditions like LSS can easily be treated using minimally invasive decompression. During the procedure, you will be under sedation to help you relax. Your doctor will use a special sculpting tool to make an incision. The incision will go through the bones and make the spinal canal wide. Excess ligament tissue and small pieces of bone are removed through a small incision in your back.
Your doctor can inject contrast to help them see the spine. A contrast injection will also enable the doctor to guide the tools into the proper position. The procedure can be repeated at an additional interlaminar level once the spinal stenosis treatment at one level is complete. If your physique is amenable, your doctor can perform the procedure using one skin puncture at two adjacent spinal levels. After the procedure, suturing is not required.
MILD is usually a short procedure carried out in under 45 minutes. The MILD procedure aims to stabilize the joints of the spine and the vertebral bones to relieve the pressure exerted on the spinal cord. The pain will dissipate because the spinal canal is widened during the procedure, and the nerves are no longer compressed.
Patient Selection and Preoperative Considerations for Minimally Invasive Decompression
It is crucial to establish the diagnosis and etiology of LSS to determine patient candidacy for the MILD procedure. The physical examination and history of the patient confirm the diagnosis of symptomatic LSS. Etiology is generally established with imaging modalities. Neurogenic claudication is the most consistent finding in symptomatic spinal stenosis. This could include less or no pain while lying in a recumbent position, sitting, or resting. However, you feel progressive leg, buttock, or back pain that could have mechanical and neuropathic components upon walking or standing. This pain usually stops after you lie down or sit down.
Unlike a physical examination, medical history is typically more sensitive in ascertaining whether you have LSS. However, physical examination, including reflex, sensory, and motor testing, is crucial for patients with LSS. Specific physical examination findings can be helpful, including the loss of normal lumbar lordosis that becomes evident when you walk in a forward flexed posture.
Appropriate imaging confirms the diagnosis and etiology of stenosis once medical history and physical examination suggest LSS. In this case, the imaging modality that your doctor will recommend is a lumbar spine MRI. A CT scan could also be appropriate if an MRI is contraindicated. Generally, you must meet the following criteria to qualify for the MILD procedure:
- LFH (LF > 2.5 mm).
- Conformation of stenosis on imaging.
- Symptomatic LSS or presence of neurogenic claudication.
Before you undergo a MILD procedure, your doctor must account for the following contraindications:
- Presence of systemic infection.
- Coagulation or presence of bleeding disorders.
- Presence of higher than grade II Spondylolisthesis.
- Presence of localized site of infection at the site of the procedure.
- Prior spine surgery at the intended level of treatment.
Post MILD Care
Unlike invasive open spine surgery, the MILD procedure is faster, safer, and you will recover within a short time. Typically, after undergoing MILD, you can leave the hospital after a couple of hours. You do not require post-procedure antibiotics. The doctor will observe you in the recovery area until sedation clears. You can ambulate freely at home. The pain associated with the treatment will fade away in a few days.
Your doctor will conduct a neurological examination before you leave the hospital. The doctor will likely advise you to start rehabilitation shortly after the surgery. Rehabilitation can include physical therapy. Physical therapy will assist in strengthening your back muscles to help you regain mobility. Your doctor could schedule a follow-up visit in two weeks to assess the extent of symptom relief. Your final evaluation for improvement can only be feasible several months after the procedure.
The Benefits Of Minimally Invasive Decompression
The primary goal of minimally invasive decompression is to stabilize your vertebral bones and spinal joints by relieving the pressure applied to the spinal nerves. Unlike invasive procedures like spine surgery, minimally invasive decompression is faster, safer, and has a shorter recovery period. There is minimal trauma to the muscles and soft tissues. The leading benefits of minimally invasive decompression are:
- Reduced risk of muscle damage because there is less or no cutting of the muscles.
- Less blood loss, unlike in the case of surgery.
- Better cosmetic results because the doctor only makes tiny spinal incisions that are less noticeable.
- There is little to no risk of infection or post-operative pain.
- Faster recovery from the surgery because a patient needs little to no recovery time.
- No reliance on pain-relieving medications after the treatment.
Limitations of Minimally Invasive Decompression Procedure
Mild is a surgical procedure done by non-surgeons. This procedure is also ineffective for all patients with spinal stenosis, including those with more severe cases. It is only applicable to patients with moderate to mild spinal stenosis. You also still experience pain and mobility issues even after undergoing the procedure. You could require additional surgery and treatment to deal with the symptoms.
The MILD procedure could cause nerve damage, infections, and bleeding like any other surgical procedure. You need to be aware of the risks before undergoing the procedure, even if they are relatively low-risk MILD procedures. The MILD approach also restricts you from undergoing other treatments like spine surgery later, if needed.
The MILD procedure is also costly, and insurance does not cover it because it is relatively new. You need to consult your insurance company to ascertain whether the treatment is covered and whether you must meet some cash costs. The costs associated with this procedure could deter patients with limited financial resources and those without insurance.
Some of the risks associated with minimally invasive decompression include:
- A patient can adversely react to anesthetics.
- Unexpected blood loss can occur during the procedure.
- Localized infection at the incision site, even if the doctor only makes a small incision.
Find Minimally Invasive Decompression Services Near Me
If you suffer from chronic lower back pain, minimally invasive decompression can eliminate the problem. You should ensure that only an experienced doctor performs the procedure for the best results. If you need reliable, minimally invasive decompression services in Los Angeles, we invite you to contact Dr. George Rappard. Contact us at 424-777-7463 to speak to our team.