About MILD (Minimally Invasive Lumbar Decompression)
Lumbar spinal stenosis is a narrowing of the spinal canal in the low back. A common cause is thickening of the ligamentum flavum, a ligament along the back of the canal. The narrowing crowds the nerves, causing leg pain, heaviness, or numbness that gets worse with standing or walking and eases with sitting or bending forward.
MILD uses special instruments passed through a small port, about the width of a pencil, under X-ray guidance. Small pieces of the thickened ligament and bone are removed to create more room for the nerves. There are no stitches in most cases, no implants, and general anesthesia is usually not needed.
MILD is performed as an outpatient procedure in an appropriate procedure facility rather than a regular exam room. It is one step on a range of stenosis options, between conservative care and open surgery.
What happens during treatment
- 1.
Dr. Chen reviews your symptoms, exam, and MRI to confirm stenosis caused mainly by a thickened ligament.
- 2.
On the day of the procedure, you lie face down and receive local anesthetic and, usually, light sedation.
- 3.
Under X-ray guidance, a small port is placed through the skin, and specialized tools remove small portions of the thickened tissue.
- 4.
A small bandage covers the site, and you go home the same day with a driver.
Who may be a good candidate
- Adults with lumbar spinal stenosis who have leg pain, heaviness, or numbness with standing or walking.
- People whose MRI shows a thickened ligamentum flavum as a main cause of narrowing.
- People who have not improved enough with rehab or epidural injections and want to avoid or delay open surgery.
- People who may not be good candidates for larger spine surgery because of other health conditions.
Recovery
Most people walk the same day and return to light activity within a few days. Soreness at the site is common for about a week. Heavy lifting is limited for a short period. Many people notice they can stand and walk longer over the following weeks, and a walking and strengthening program helps build on that improvement.
Risks and limits
Possible risks include soreness, bleeding, infection, a tear in the covering of the spinal fluid, and, rarely, nerve injury. Symptoms may not improve, or stenosis may progress over time. MILD is not suited to stenosis caused mainly by disc bulges or bone spurs, significant spinal instability, or severe narrowing that needs open surgery. Seek urgent care for new weakness, numbness in the groin, or loss of bladder or bowel control.
What to expect at your visit
- 1.
We listen first
Your visit opens with a real conversation: how the problem started, what you have already tried, and the activity you want back.
- 2.
Exam and in-office ultrasound
A hands-on exam, then ultrasound at the exam table, often while you move, so your physician can see the tendon, joint, or nerve involved.
- 3.
A clear diagnosis and plan
You leave knowing what is wrong and what your options are, from strength-based rehab to procedures, and why we recommend each one.
- 4.
Treatment and follow-through
Most procedures happen here in the office. We coordinate with your physical therapist and check progress against the goals you set.
Questions about MILD
- Is MILD surgery?
- MILD is a minimally invasive outpatient procedure done through a small port, typically with local anesthetic and light sedation. It does not involve a large incision, implants, or general anesthesia in most cases.
- Where is the MILD procedure performed?
- It is done as an outpatient procedure in a sterile procedure facility with X-ray guidance, not in a standard exam room. Dr. Chen will review where and how to prepare.
- Can I still have spine surgery after MILD?
- Yes. MILD does not rule out future surgery. If your symptoms progress or MILD does not help enough, we can coordinate a referral to a spine surgeon.