Minimally Invasive Lumbar Decompression
What is Minimally Invasive Lumbar Decompression or MILD?
MILD is a safe, minimally invasive, fluoroscopically (X-Ray) guided outpatient procedure, that may help patients with lumbar spinal stenosis stand longer and walk farther, with less pain. MILD is performed through a 5.1 mm treatment portal that requires no general anesthesia. Patients can have the procedure performed in an ambulatory surgery center with local anesthesia with or without light sedation. No implants, and no stitches are used. MILD safely decompresses the spinal canal by removing small portions of lamina (bone) and thickened ligamentum flavum on the back side of the spinal canal. The procedure takes 15-30 minutes and leaves the structural stability of the spine intact unlike some of the more invasive alternatives such as laminectomy surgery.
Safe by Design:
- Tiny incision – 5.1 mm (size of a baby aspirin)
- Constant visualization of the instruments and treatment area via X-ray guidance
- Instruments designed for safety
- All activity is posterior to the dura, minimizing risk to nerve structures
Outpatient Procedure:
- No general anesthesia required
- No stitches
- No implants
- Low complication rate
Why is MILD done?
The MILD procedure is done to help patients suffering from lumbar spinal stenosis.
Patients with stenosis have difficulty walking far distances and pain when standing for long periods of time. If this is due to a thickened ligament that is compressing their spinal canal, MILD may help. By removing this bottleneck, patients can stand for longer periods of time, with decreased overall pain.
Who is a Candidate?
Patients diagnosed with Lumbar Stenosis, who have difficulty standing for long periods of time, walking any distance without assistance and pain in their low back / legs, who have failed or no longer get relief from spinal injections. Lumbar spinal stenosis is primarily a degenerative, age-related narrowing of the lower spinal canal that results in compression of the nerve roots and subsequent neurogenic claudication symptoms. Neurogenic claudication symptoms include pain, tingling, and numbness in the lower back, legs, or buttocks that worsen with lumbar extension (standing or walking) but improve with lumbar flexion (sitting or bending forward). It has been reported that as many as 94% of patients with lumbar spinal stenosis have neurogenic claudication.
The narrowing is caused by degenerative changes in the lumbar spine and is often multi-factorial in nature. Common co-factors include disc bulge, osteophytes, and ligamentum flavum thickening. Conservative symptom management is often the first course of treatment, but if symptoms persist or get worse, a decompression procedure is required to alleviate the compression of the nerve roots.
What type of result can I expect?
Study data show that 79% of patients experience a significant reduction in pain and significant increase in mobility. Most patients report some improvement in the weeks-months following the procedure. However, the overall results may vary.
Medial Branch Nerve Blocks/RFA
A medial branch nerve block is a minimally invasive injection procedure that involves injecting a small amount of local anesthetic, with or without a corticosteroid, near the medial branch nerves – the small nerves near the facet joints of the spine that carry pain signals from the joints to the brain. The injection aims to block the pain signals transmitted through the medical branch nerves and produce targeted pain relief.
Radiofrequency ablation (RFA) uses heat to destroy tissue. For pain management, radio waves are sent through a precisely placed needle to heat an area of the nerve. This prevents pain signals from being sent back to your brain. RFA is considered for long-term pain conditions, especially of the neck, lower back, or arthritic joints that haven’t been successfully treated with other methods.
Spinal Cord Stimulators
Spinal cord stimulation is a pain management treatment that helps limit pain in your legs, back neck and arms. The device works by using a pacemaker type battery which sends electrical pulses up the spinal cord that stop your brain from receiving certain pain signals. A trial period of seven days allows you to test-drive the device to see if it will not only reduce your pain but increase your functional abilities as well. The trial is performed in the office and involves no incisions with little to no down time. If you deem the device effective, you can opt to have the system implanted. Patients who suffer from chronic neuropathic pain whether it be following a back/neck surgery, diabetic related or peripheral (sciatic) tend to see the best response.
(DRG) Dorsal Root Ganglion
Dorsal Root Ganglion stimulation is an advanced treatment designed to provide relief from chronic neuropathic pain of the extremities. Many describe the Dorsal Root Ganglion as the “brain” of the nerve, and each DRG correlates to a different part of the body, which allows for a targeted treatment versus broad coverage of your pain. This therapy involves a temporary trial period performed in the office, very similar to that of a spinal cord stimulator. If effective, you can opt to have the device implanted at a later time. DRG stimulation has been shown to be effective in the treatment of pelvic pain, post op hip/knee pain, ankle/foot pain, phantom limb pain, and complex regional pain syndromes.
INTRA-X
Ifuse INTRA Allograft is designed to provide SI joint stabilization and promote fusion in patients who have sacroiliac joint dysfunction. The minimally invasive iFuse INTRA allograft procedure is performed entirely through a small, two-centimeter incision in the lower back. Using a soft tissue protector, the small triangular allograft is implanted into the SI joint. The procedure typically takes less than an hour.(PNS) Peripheral Nerve Stimulation
The SPRINT Peripheral Nerve Stimulation (PNS) System is a non-surgical drug-free neurostimulation treatment that may offer pain relief to people who have been suffering with chronic pain in their back, shoulders, knees, head/neck or are experiencing other nerve-related pain. This breakthrough treatment targets select nerves which may reduce the pain you have lived with for far too long.
An Overview of SPRINT PNS
A short-term treatment of only 60 days designed to provide long-term relief, the SPRINT System is an innovative option to treat your chronic pain, potentially avoiding the need for opioids, other pain medications or a permanent implant.
With the SPRINT System, a tiny threadlike wire called a MicroLead™ about the size of two human hairs, is placed under your skin to deliver stimulation near a nerve that is causing pain. A small wearable device sends gentle electrical pulses through the MicroLead to the nerve. A simple hand-held remote allows you to control the simulation level to find a setting that works best for you. After 60 days, the MicroLead is removed, and treatment is complete. While results may vary, a majority of patients in clinical studies have seen significant and sustained relief of pain and/or interference of pain with their daily activities following the treatment.
You may be wondering what risks are associated with the SPRINT PNS System. The most common adverse event reported in clinical studies was skin irritation due to components being adhered to the skin (which may include inflammation, mild blistering, and/or redness). Other less-reported events included itching at the lead exit site, pain after lead placement, and infection. The majority of the adverse events in clinical studies were resolved with little to no intervention within a few days, and none were classified as serious. Similar adverse events have been reported outside of clinical studies. Infections have been reported for 1-2% of patients. Serious adverse events have been rare. Click the link to see Patients’ Frequently Asked Questions.
The SPRINT System is covered by Medicare. Many private insurance companies also provide coverage following prior authorization. The company that manufactures the SPRINT system has a dedicated team of reimbursement specialists called the SPRcare® Patient Access Team, who offer support for facilitating commercial insurance coverage and can, with your permission, assist you in determining your insurance coverage and working with you and your doctor to obtain necessary approvals.
SPRINT PNS Mechanisms of Action in the Treatment of Chronic Low Back Pain
What to Expect When Using SPRINT
Minuteman
Spinal fusions for select patients are becoming less invasive.
The Minuteman device from Spinal Simplicity utilizes a lateral approach for implantation of spinal hardware.
The lateral approach preserves numerous spinal ligaments and muscles, minimizing trauma to the patient whilst creating the perfect environment for fusion.
Additionally, patients who undergo spinal fusion with Minuteman are almost always able to walk the same day as surgery!
LinQ
The LinQ Stabilization System is a minimally invasive option for patients suffering from SI joint dysfunction. The LinQ SI joint stabilization system provides SI joint dysfunction patients with a minimally invasive option to combat pain. After a thorough diagnostic process, Dr Cicchetti may help alleviate, and in many cases eliminate, chronic pain by placing a single LinQ allograft into the SI joint.
This single implant may help patients immediately regain joint stability, and with its large graft window, the LinQ SI joint stabilization system helps create an ideal environment for long-term fusion.
What differentiates LinQ from other options is the abundance of clinical evidence & data and the high likelihood of long-term fusion and improved quality of life.