Vertos Medical Blog

Alternatives to Back Surgery

Published June 8, 2021

Patients with back pain caused by lumbar spinal stenosis (LSS) can often feel like they have only two options. They feel stuck between minor relief from over-the-counter pain medication, physical therapy, and chiropractic care, and more promising relief from invasive, costly back surgery.

The good news is, there are many options to treat back pain, and specifically the back pain associated with lumbar spinal stenosis (LSS).  LSS is a condition in which the lower spinal canal narrows and compresses the spinal nerves in the lower back, contributing to increased pain and mobility issues. Up to 85% of spinal canal narrowing is caused by thickened ligament in the spine, a major root cause of lumbar spinal stenosis (LSS).

Finding the Right Doctor

The first step in treatment is to talk to a pain management doctor, also commonly referred to as interventional pain specialists. These are physicians who specialize in treating pain, and are able to find the best course of action for your specific condition. Here is an overview of some treatments your doctor may recommend.

Chiropractic Care

Chiropractic care is a common treatment for back pain. In fact, according to this Gallup article, 28% of Americans say they would most likely see a chiropractor for back pain. As defined by WebMD, chiropractors use hands-on manual therapy and manipulation to adjust the musculoskeletal structure, particularly the spine, in an effort to enable the body to heal itself without surgery or medication. According to a 2018 study, “Chiropractic care, when added to usual medical care, resulted in moderate short-term improvements in low back pain intensity and disability.” In some cases, chiropractic care will not resolve the pain or mobility issues for a patient with lumbar spinal stenosis (LSS).

Physical Therapy

Physical therapy uses movement and exercise to heal and repair muscles and skeletal injuries. With physical therapy, a trained therapist will provide an examination of your range of motion, pain level, and mobility. Based on their diagnosis, they will work with patients on physical intervention and rehabilitation, often both in the office, as well as recommending at-home exercises. Physical therapy can provide relief for some patients with back pain, but for a diagnosis of lumbar spinal stenosis (LSS), it may not be enough.

Pain Medicine

There are two types of medication used when treating back pain. The first, is over-the-counter medication such as Tylenol, Advil, or Aleve. Since inflammation is a common component of spinal stenosis, patients may achieve pain relief from these anti-inflammatory and pain-relieving drugs, although they may not be strong enough to deal with significant back pain. There is also prescription pain medication prescribed by a doctor, which can help relieve more severe back pain. This can manage the pain for a time, but not only does it not address a major root cause of stenosis, it comes with a risk of addiction or abuse. According to the Centers for Disease Control and Prevention, 4.3 million Americans engaged in non-medical use of prescription opioids in a one-month period.

Epidural Steroid Injection (ESI)

This is the injection of a small dose of anti-inflammatory medication into the lower back. The injection works by reducing inflammation, which reduces pressure on the spine. While injections can help reduce inflammation, pain, and irritation in areas where nerves are being pinched, according to the Cleveland Clinic, “corticosteroids [anti-inflammatory medication] can weaken bones and nearby tissue over time.” Repetitive epidural steroid injections (ESIs) may provide short-term relief for radiating pain of the compressed nerve root, but do not address a major root cause of stenosis.


In this surgical procedure, interspinous spacers, or implants, are placed between vertebrae (spinal bones) affected by stenosis. This procedure is seen as less invasive than traditional back surgery procedures, however, according to an article published in the peer-reviewed medical journal, Pain Medicine: “Not all patients are suitable for treatment with an interspinous spacer.” This may include patients with osteoporosis, or overgrowth of bone, to be at risk of a spinous process fracture (break in a part of the spinal bone). It may also include patients with spondylolisthesis, a spinal disorder in which a vertebra (bone) slips forward onto the bone below it, due to a risk of posterior migration of the implant (not staying in place).

Traditional Back Surgery

Back surgery for lumbar spinal stenosis consists of a surgical procedure that requires general anesthetic. There are different types of surgeries, depending on the severity of the stenosis, but most surgeries involve removing portions of bone, bony growths, or discs that are crowding the spinal canal and pinching spinal nerves. Often accompanied by a hospital stay, subsequent pain medication, and a long recovery period, traditional surgery is usually considered when all other options have failed to provide relief. According to, it takes 3 to 12 months to return to normal daily activities after surgery, and the success rate for pain relief is between 70% and 90%.

The mild® Procedure

mild® stands for minimally invasive lumbar decompression and is an option that may be considered after the first ESI fails and before more invasive options like back surgery. It’s a short, nonsurgical procedure, performed through a tiny incision (about the size of a baby aspirin). To restore space in the spinal canal and reduce the compression of the nerves, a mild® Doctor uses an imaging machine and specialized tools to remove small pieces of bone and thickened ligament. The mild® Procedure has a safety profile similar to an ESI and according to a study performed at the Cleveland Clinic, mild® helped 88% of patients avoid back surgery for at least 5 years while providing lasting relief.

How Is mild® Different From Traditional Back Surgery?

The mild® Procedure is different from traditional back surgery because it is an outpatient procedure that does not require general anesthesia, implants, stitches, steroids, or opioids. Typically completed in less than an hour, mild® has a safety profile similar to an epidural steroid injection (ESI), but with lasting results. That’s because mild® addresses a major root cause of lumbar spinal stenosis (LSS) by removing small pieces of bone and thickened ligament. This restores space in the spinal canal, which reduces the compression of the nerves. Additionally, mild® can be performed as a steroid-free procedure, which limits immunosuppression risks associated with epidural steroid injections (ESIs).

Thousands of patients are treated every year with mild®, and the procedure is supported by FDA clearance, national Medicare coverage, leading medical institutions, and national medical societies. Thirteen clinical studies and over 25 peer-reviewed articles demonstrate that the mild® Procedure is just that — mild.

Dr. Mark Coleman, an ABA Certified Pain Medicine Specialist and President of Clinical Operations at the National Spine & Pain Centers, describes mild® as “taking care of the problem by thinning the ligamentum flavum (thickened ligament) on an outpatient basis, where patients come in and they get the procedure the very same day.” As patients typically resume normal activity within 24 hours with no restrictions,patients are “often better the next day, and the risk that they’re taking is so minimal relative to other procedures and surgeries that attempt to do the same thing,” Dr. Coleman continues.

mild® patient Linda Cisco described “little discomfort” after her procedure, and called mild® a “life-changing experience.” Not only is she able to go shopping without looking for a chair to rest, she says she “doesn’t even think about that anymore.” Four weeks after her procedure she was back out doing her favorite thing, hiking in the mountains, and is looking forward to taking her newfound freedom to even greater heights in the future. “It’s hard for me to imagine what I can’t do,” Linda says about life after the mild® Procedure. “I think I can go back and do things I did in my thirties with the same level of enjoyment and gusto and stamina…it’s quite possible I could climb a 14er again!”

Symptoms of lumbar spinal stenosis (LSS), including pain or numbness in the lower back when standing and heaviness or tingling in the upper legs or buttocks when walking, may be treated, and in Linda’s case forgotten, when it comes to the mild® Procedure. Now that you have a better understanding of the treatment options for lumbar spinal stenosis (LSS), as well as alternatives to back surgery, take the mild® Patient Survey to find out if mild® may be right for you and, if it is, find a mild® Doctor near you.

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