Minimally Invasive Procedure to Treat Lumbar Spinal Stenosis Safe and Effective Over Two Years

By Erik MacLaren, PhD

Patients who underwent the minimally invasive lumbar decompression (MILD) procedure for lumbar spinal stenosis (LSS) found significant improvement in function and pain, with no serious procedure-related adverse events (AEs) after 2 years, according to results of the prospective MiDAS ENCORE study presented at the 35th Annual Meeting of the American Academy of Pain Medicine (AAPM).

Tim J. Lamer, MD, Mayo Clinic, Rochester, Minnesota, presented data collected at a 2 year follow-up for MiDAS ENCORE, in which investigators evaluated 143 patients who underwent MILD and 131 who underwent epidural steroid injections. The researchers reported the incidence of device- and procedure-related AEs, reoperations, and assessments of function and pain.

At 2 years follow-up, 1.3% of patients experienced a procedure or device-related AE, and a total of 5.6% of patients underwent reoperations. These results were better than those published for alternative procedures, including interspinous process distraction or surgical decompression.

Dr. Lamer noted that patients receiving spacer implants or open decompression for LSS are no longer candidates for MILD, while MILD itself does not rule out any subsequent treatment options. This characteristic, combined with the procedure’s safety and durability of responses, he noted, make MILD a prime candidate for first-line treatment of LSS.

The MILD procedure uses a set of proprietary instruments to debulk the ligament through a 5.1-mm access portal designed to minimise damage to the tissue. Direct decompression is achieved with the removal of very small amounts of bone and tissue, and without leaving behind implants.

Spinal comorbidities, including bulging disc, foraminal narrowing, facet hypertrophy, and other conditions were common, and 95% of patients presented with 5 or more spinal comorbidities in this study.