Minimally Invasive Lumbar Decompression (MILD® Procedure)

Lumbar spinal stenosis, or LSS, is a condition in which the spinal canal narrows in the lower back. This places pressure on the spinal nerves. A common cause is thickening of a spinal ligament called the ligamentum flavum. As this ligament enlarges, it reduces the space within the spinal canal.

This condition may cause:

• Lower back pain
• Leg pain
• Numbness
• Tingling
• Difficulty standing and walking for long periods

UF Health spine surgery and pain management specialists offer the minimally invasive lumbar decompression, or MILD, procedure for specific patients with lumbar spinal stenosis. Candidates for MILD have a form of LSS caused primarily by thickening (hypertrophy) of the ligamentum flavum, a spinal ligament.

The MILD surgical procedure is:

• FDA-cleared
• Image-guided
• Minimally invasive

MILD is performed through a very small incision. It removes small portions of excess ligament tissue to reduce pressure on the spinal nerves, providing pain relief and improving function.

How is the MILD procedure performed?

The MILD procedure is performed through a small incision (the size of a baby aspirin) using specialized instruments and fluoroscopic (X-ray) guidance to target the affected area of the spine.

The procedure is typically performed in an outpatient setting with local anesthesia and sedation. General anesthesia is usually not required.

During the procedure, the physician removes small portions of thickened ligament tissue that are contributing to the narrowing of the spinal canal. This increases space around the spinal nerves, reducing nerve compression. The goal is to improve mobility, regain ability to walk long distances and reduce pain.

The procedure usually takes about one hour. Most patients are monitored briefly afterward and discharged the same day.

Who may be a candidate for the MILD procedure?

Your provider may recommend the MILD procedure if you have lumbar spinal stenosis and continue to have symptoms despite pain management treatments, such as:

• Physical therapy
• Oral anti-inflammatory or pain medications
• Activity modification
• Epidural steroid injections

Common symptoms include:

• Lower back pain
• Pain radiating into the buttocks or legs
• Numbness, tingling or heaviness sensation in the legs
• Difficulty standing or walking for long periods
• Relief of symptoms when sitting or leaning forward

How is lumbar spinal stenosis diagnosed?

Lumbar spinal stenosis is diagnosed based on medical history, physical examination and imaging studies. Symptoms often develop gradually and may worsen over time.

Imaging tests may include:

• MRI
• CT scan
• X-ray

These studies help identify narrowing of the spinal canal and compression of spinal nerve structures. They also help determine whether MILD is appropriate as part of a spine surgery or pain management treatment plan.

What are the risks of the MILD procedure?

The MILD procedure is generally safe, it is reported to have a similar complication rate than an epidural steroid injection (which is quite low.) However, risks may include:

• Bleeding
• Infection
• Allergic reaction to medications
• Temporary soreness at the treatment site
• Nerve injury
• Spinal fluid leak (dural tear)
• Incomplete or limited pain relief

Your physician will review risks and benefits with you before treatment.

What to know before the procedure

Following pre-procedure instructions helps reduce risks and supports recovery.

Tell your provider:

• If you are or may be pregnant
• All medications you take, including over-the-counter drugs and supplements
• Any allergies or medical conditions

Before the procedure:

• You may be asked to stop blood-thinning medications several days before
• Your provider will tell you which medications to take on the day of the procedure
• You may be asked not to smoke before treatment

On the day of the procedure:

• You may be instructed not to eat or drink for several hours before
• Take approved medications with a small sip of water
• Arrange for someone to be at the ambulatory center during the procedure, drive you home and stay with you overnight.

What to know after the procedure

Most patients go home on the same day. After the procedure:

• Mild soreness at the incision site is common
• Walking is encouraged soon after the procedure
• Activity is increased gradually as tolerated
• Heavy lifting and strenuous activity should be avoided for a period of time as directed by your provider
• Some patients experience pain relief soon after treatment, while others improve gradually over several weeks

Your provider may recommend follow-up care through spine surgery or pain management. This can include physical therapy or other supportive treatments, depending on recovery.