PAIN MANAGEMENT

Procedure performed on an outpatient basis

Minimally Invasive Lumbar Decompression (MILD) is now a procedure that can be performed on an outpatient basis for individuals suffering with progressive leg pain secondary to spinal canal stenosis due to ligamentum flavum hypertrophy.

SPINAL CANAL STENOSIS, also known as lumbar spinal stenosis, is now the most commonly diagnosed spinal disease in the U.S. geriatric population. Each year, in the U.S. alone, approximately 1.5 million individuals are diagnosed with the condition.

A degenerative condition of the spine, ligamentum flavum hypertrophy most commonly occurs in the elderly where the spinal canal shrinks and impinges on the various nerves of the spinal cord.

Patients who suffer with ligamentum flavum hypertrophy typically experience progressive leg pain when walking.  This occurs when a ligament increases in size causing an encroachment of the spinal canal, which is referred to as spinal canal stenosis.

Because of the narrowed canal, progressive pain develops when walking any distance.  When a patient sits down or relaxes, the leg pain usually subsides.

As the spinal canal progressively narrows due to thickening and/or bulging of soft tissue and venous congestion, patients develop pain that severely limits daily activities such as walking and, in severe cases, even standing.  Significant numbers of Americans suffer from the chronic pain and immobility caused by spinal canal stenosis.

Common Spinal Disease In Elderly

Spinal canal stenosis, also known as lumbar spinal stenosis, is now the most commonly diagnosed spinal disease in the U.S. geriatric population. Each year, in the U.S. alone, approximately 1.5 million individuals are diagnosed with the condition.

And the number of spinal canal stenosis patients is predicted to increase by 18 million over the next ten years, as the population over age 50 continues to grow exponentially.

About 900,000 patients receive some form of treatment for spinal canal stenosis, which may include epidural steroids, facet denervation, or open laminectomy.  Of those 900,000 patients, 220,000 undergo open laminectomy procedures with a complication rate of approximately 13 percent.

Symptoms of Spinal Canal Stenosis

People who have the condition may have leg pain or numbness. Your legs might also feel cramped, tired, or weak. These symptoms usually start when you are standing or walking. Often, the symptoms get better if you sit, crouch or lie in the fetal position (on your side with your knees tucked up to your chest).  It’s thought that these positions “open” the lumbar canal and take the pressure off the nerves that go to the legs.

Back pain is not typical of this condition.  When your legs become painful with progressive activity, this usually means that the spinal canal is being squeezed and causes pain down both legs.

New Treatment Option

My patients with this condition ask me if there’s anything new out there that can help them.  Now I’m happy to report that, yes, there is.  It’s called MILD, short for Minimally Invasive Lumbar Decompression.  Developed by Vertos Medical, it is performed on an outpatient basis and has proven to be highly effective.

LIGAMENTUM flavum hypertrophy most commonly occurs in the elderly where the spinal canal shrinks and impinges on the various nerves of the spinal cord.

Viable Option for Thousands

This new FDA-cleared procedure represents a viable option for patients with progressive bilateral leg pain that hasn’t responded to epidural steroid injections along with physical therapy.  It is also an alternative for those concerned about the invasiveness of major surgery such as laminotomy, laminectomy, and spinal fusion.

Since the MILD procedure is minimally invasive, shorter inpatient therapy and recovery compared with other treatment options for spinal canal stenosis may apply.

It’s estimated that 660,000 patients suffering with spinal canal stenosis haven’t been given the opportunity to undergo the MILD procedure simply because they don’t know about it.

Minimally Invasive Procedure

During the procedure, an intravenous access line will be obtained and an antibiotic (typically Ancef) will be administered.  Next, with the use of fluoroscopy, visualization is achieved and access is obtained with a guidance needle.

Once confirmation is done with an epidurogram and contrast, the access needle is used with a bone sculptor to open a wedged area.  Then a tissue debulker is used to reduce the pressure placed on the canal from the ligament.

When one to two levels have been debulked, an epidurogram is used to see if the canal is open; if it is, the procedure is usually over.

Afterwards, the patient will typically be sore and ice is applied to the area treated; analgesics are usually not needed.  Patients experience relief almost immediately and begin to walk and stand with more ease.

Highly Effective Results

Several weeks after the procedure, patients are typically performing tasks that they couldn’t do before the MILD procedure was performed.  Patients who have undergone the MILD treatment report reduction in pain and improvement in mobility.  Similar results have been demonstrated six to 12 months after the MILD procedure.

Dr. Stan Golovac

ABOUT THE AUTHOR

Dr. Golovac is the co-director of Space Coast Pain Institute. Dr. Golovac completed his education at UTESA University in 1985, where he received his Doctor of Medicine. Upon graduation, Dr. Golovac completed his postgraduate training in Family Practice Residency Program at St. Mary Hospital in New Jersey and in the Department of Anesthesiology at Jackson Memorial Hospital in Miami. Dr. Golovac gained extensive clinical experience in anesthesiology, emergency room medicine and alternative services. He served as Assistant Clinical Professor of Anesthesia at the University of Miami Jackson Memorial Center for several years, and then as a practicing Pain Consultant in the Miami area. He currently utilizes his expertise at Cape Canaveral Hospital/Health First Pain Management and the Space Coast Surgery Center of Pain Management. You may reach Dr. Golovac by calling 321-784-8211.

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