Minimally Invasive Lumbar Decompression: A Review of Indications, Techniques, Efficacy and Safety

Abstract

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.

Keywords::

• ligamentum flavum hypertrophy
• lumbar spinal stenosis
• mild^®
• minimally invasive lumbar decompression
• neurogenic claudication
• review

Financial and competing interests disclosure

This publication was supported by an unrestricted grant to the American Society of Pain & Neuroscience (ASPN) from Vertos Medical for editorial assistance. TD: Consultant for Axonics, Bioness, Abbott, Vertos, Vertiflex, Nevro, Medtronic, CornerLoc, Nalu and SPR; minor equity interest in Stimgenics, Nalu, SPR. DS: Consultant for Flowonix, Nevro, Medtronic, SPR, PainTeq, Vertos and Vertiflex. SW: Vertos Leadership Council. The author’s yearly amount received for this work does not exceed US$10K. NJ: Consultant/Advisory Board for Vertos, Abbott, Flowonix, CornerLoc and Medtronic. JW: Consultant for Abbott, Vertos, Medtronic, Omnia Medical and Boston Scientific; Advisory Board for Abbott. JJ: Research funding from Nevro and Boston Scientific; Consultant for Nevro, Abbott, Boston Scientific and Stimwave. MM: Consultant for Abbott, SI Bone and Nalu Medical; research for Abbott; equity interest in PrescribeFIT LLC. SG: Consultant for Abbott, Saluda and Vertos. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the article apart from those disclosed.

No writing assistance was utilized in the production of this article.

Additional information

Funding

This publication was supported by an unrestricted grant to the American Society of Pain & Neuroscience (ASPN) from Vertos Medical for editorial assistance. TD: Consultant for Axonics, Bioness, Abbott, Vertos, Vertiflex, Nevro, Medtronic, CornerLoc, Nalu and SPR; minor equity interest in Stimgenics, Nalu, SPR. DS: Consultant for Flowonix, Nevro, Medtronic, SPR, PainTeq, Vertos and Vertiflex. SW: Vertos Leadership Council. The author’s yearly amount received for this work does not exceed US$10K. NJ: Consultant/Advisory Board for Vertos, Abbott, Flowonix, CornerLoc and Medtronic. JW: Consultant for Abbott, Vertos, Medtronic, Omnia Medical and Boston Scientific; Advisory Board for Abbott. JJ: Research funding from Nevro and Boston Scientific; Consultant for Nevro, Abbott, Boston Scientific and Stimwave. MM: Consultant for Abbott, SI Bone and Nalu Medical; research for Abbott; equity interest in PrescribeFIT LLC. SG: Consultant for Abbott, Saluda and Vertos. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the article apart from those disclosed. No writing assistance was utilized in the production of this article.