Find a Doctor Offering More Than Epidural Steroid Injections for Lower Back Pain
January 25, 2022
There’s good news for patients suffering from chronic lower back pain caused by lumbar spinal stenosis (LSS), as effective treatment options have become more widely available. Traditionally, administering a series of epidural steroid injections (ESIs) had been considered the standard of care, but the short-term results—typically lasting less than 6 months—left many doctors and patients looking for a more durable solution. Rather than enduring one injection after another, up to 2-3 injections per year, the minimally invasive mild® Procedure has become an increasingly sought after alternative for patients with LSS.
A recent study published in Future Medicine, highlighted some of the top reasons doctors and patients are making the move to the mild® Procedure, or, minimally invasive lumbar decompression. The mild® Procedure is a treatment option that addresses a major root cause of LSS, requires only local anesthetic and light sedation, and leaves no implant behind.
Here’s an overview about ESIs, the mild® Procedure, and how to find an interventional pain provider capable of telling you more about the procedure and its potential benefits.
Epidural Steroid Injections
Epidural steroid injections—medication injected in the lower spine to reduce swelling and offer pain relief—are typically offered to lumbar spinal stenosis patients when non-medical care methods like exercise and physical therapy have failed to provide relief.
The steroid medication in the injection is believed to reduce inflammation, which relieves pain. However, injections only treat the symptoms of stenosis and do not address the problem’s root cause.
The effects of an epidural steroid injection typically last less than 6 months so patients generally require 2-3 injections per year. Repeat steroid use is known to increase risk of infections and may cause bone loss (osteoporosis).
“Being in pain constantly is frustrating. I’m an active person and I wanted to get better. My orthopedic surgeon diagnosed me with spinal stenosis and ordered 3 injections of the cortisone over a period of about 4 weeks. The first shot took away the severe pain, but I was still hurting. And that remained the case after the second and third injections.
I waited about 2 months and then he gave me 2 options: open back surgery, with metal plates between the vertebrae, or get more shots. I wanted something simple that would make me better, and that’s when I found the mild® Procedure.” -Faye, mild® Patient
Minimally Invasive Lumbar Decompression: The mild® Procedure
If epidural steroid injections aren’t effective for you, it’s important to know that your interventional pain provider may offer other treatment options. Proactively discussing and considering different options can help you and your doctor make the right treatment decision at the appropriate time.
The recent study highlighted several advantages of the mild® Procedure, including:
The mild® Procedure addresses a major root cause of lumbar spinal stenosis by removing excess ligament. This restores space in the area around the spinal cord, reducing pressure on the nerves in the lower back.
The mild® Procedure has been shown to provide superior clinical performance to epidural steroid injections and provides lasting relief, with 88% of patients avoiding open back surgery for at least 5 years
The mild® Procedure is a short outpatient procedure. It is typically performed using only local anesthetic and light sedation through a single incision that is smaller than the size of a baby aspirin (5.1mm).
The procedure does not require stitches, staples, or complex bandaging. Typically, patients leave the outpatient procedure facility with a just a Band-Aid covering their incision and visit their doctor a few weeks later.
The mild® Procedure does not leave behind an implant, and patients typically resume normal activity in 24 hours with no restrictions
“After mild®, I felt great, and the results have lasted. My golf game is nearly back, too. Anybody that meets the criteria of the procedure should do it. Why live in pain if you don’t have to?” -Dante, mild® Patient
Find a mild® Doctor
Finding a doctor that offers the mild® Procedure is easy. The fastest way is to use the Find a mild® Doctor feature available on this website. The finder can help you locate a mild® provider in your preferred radius of your address, city, or ZIP code.
The best time to start searching for a mild® Doctor is today. Chronic lower back pain caused by lumbar spinal stenosis typically worsens in severity over time, making early intervention crucial to restoring healthy function, movement, and quality of life. The study discussed here supports early use of the mild® Procedure, finding that:
There is no benefit to performing multiple epidural steroid injections before the mild® Procedure
Performing multiple epidural injections delays the patient from receiving a longer-lasting, more effective mild® treatment
Performing the mild® Procedure immediately upon diagnosis of lumbar spinal stenosis with thickened ligament, or after failure of the first epidural steroid injection, is recommended
“Before the mild® Procedure, I had a hard time standing anytime at all, so that affected my baking and my cooking, sweeping the porch, pulling weeds: just everything I did, it affected it. I was probably able to walk for 10 to 15 minutes at a time. As a matter of fact, I told my family that unless something changed, we wouldn’t be having a big Christmas next year. After 2 epidural injections, I was already finished with them. Then, I had the mild® Procedure done, and it was a miracle. I do feel happier, I feel better. My friends and family can’t believe the difference. Christmas dinner is back on, because grandma’s back to cooking.” -Lynn, mild® Patient
If you’re ready to learn more about the mild® Procedure, talk to your interventional pain provider or Find a mild® Doctor today.
Benyamin RM, Staats PS, MiDAS ENCORE Investigators. mild® is an effective treatment for lumbar spinal stenosis with neurogenic claudication: MiDAS ENCORE Randomized Controlled Trial. Pain Physician. 2016;19(4):229-242.
Mekhail N, Costandi S, Abraham B, Samuel SW. Functional and patient-reported outcomes in symptomatic lumbar spinal stenosis following percutaneous decompression. Pain Pract. 2012;12(6):417-425. doi:10.1111/j.1533-2500.2012.00565.x.
2012 data from Health Market Sciences report for Vertos Medical 2013.
Data on file with Vertos Medical.
Staats PS, Chafin TB, Golvac S, et al. Long-term safety and efficacy of minimally invasive lumbar decompression procedure for the treatment of lumbar spinal stenosis with neurogenic claudication: 2-year results of MiDAS ENCORE. Reg Anesth Pain Med. 2018;43:789-794. doi:10.1097/AAP.0000000000000868.
Based on mild® Procedure data collected in all clinical studies. Major complications are defined as dural tear and blood loss requiring transfusion.
MiDAS ENCORE responder data. On file with Vertos Medical.
Jain S, Deer TR, Sayed D, et al. Minimally invasive lumbar decompression: a review of indications, techniques, efficacy and safety. Pain Manag. 2020;10(5). https://doi.org/10.2217/pmt-2020-0037. Accessed June 1, 2020.
Deer TR, Grider JS, Pope JE, et al. The MIST Guidelines: the Lumbar Spinal Stenosis Consensus Group guidelines for minimally invasive spine treatment. Pain Pract. 2019;19(3)250-274. doi:10.1111/papr.12744.
Hansson T, Suzuki N, Hebelka H, Gaulitz A. The narrowing of the lumbar spinal canal during loaded MRI: the effects of the disc and ligamentum flavum. Eur Spine J. 2009;18(5):679-686. doi:10.1007/s00586-009-0919-7.
Treatment options shown are commonly offered once conservative therapies (e.g., physical therapy, pain medications, chiropractic) are not providing adequate relief. This is not intended to be a complete list of all treatments available. Doctors typically recommend treatments based on their safety profile, typically prioritizing low risk/less aggressive procedures before higher risk/more aggressive procedures, but will determine which treatments are appropriate for their patients.
Although the complication rate for the mild® Procedure is low, as with most surgical procedures, serious adverse events, some of which can be fatal, can occur, including heart attack, cardiac arrest (heart stops beating), stroke, and embolism (blood or fat that migrates to the lungs or heart). Other risks include infection and bleeding, spinal cord and nerve injury that can, in rare instances, cause paralysis. This procedure is not for everyone. Physicians should discuss potential risks with patients. For complete information regarding indications for use, warnings, precautions, and methods of use, please reference the devices’Instructions for Use.
Patient stories on this website reflect the results experienced by individuals who have undergone the mild® Procedure. Patients are not compensated for their testimonial. The mild® Procedure is intended to treat lumbar spinal stenosis (LSS) caused by ligamentum flavum hypertrophy. Although patients may experience relief from the procedure, individual results may vary. Individuals may have symptoms persist or evolve or other conditions that require ongoing medication or additional treatments. Please consult with your doctor to determine if this procedure is right for you.
Reimbursement, especially coding, is dynamic and changes every year. Laws and regulations involving reimbursement are also complex and change frequently. Providers are responsible for determining medical necessity and reporting the codes that accurately describe the work that is done and the products and procedures that are furnished to patients. For this reason, Vertos Medical strongly recommends that you consult with your payers, your specialty society, or the AMA CPT regarding coding, coverage and payment.
Vertos Medical cannot guarantee coding, coverage, or payment for products or procedures. View our Billing Guide.
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Hall S, Bartleson JD, Onofrio BM, Baker HL Jr, Okazaki H, O’Duffy JD. Lumbar spinal stenosis. Clinical features, diagnostic procedures, and results of surgical treatment in 68 patients. Ann Intern Med. 1985;103(2):271-275. doi:10.7326/0003-4819-103-2-271.
Kalichman L, Cole R, Kim DH, et al. Spinal stenosis prevalence & association with symptoms: The Framingham Study. Spine J. 2009;9(7):545-550. doi:10.1016/j.spinee.2009.03.005.
Fukusaki M, Kobayashi I, Hara T, Sumikawa K. Symptoms of spinal stenosis do not improve after epidural steroid injection. Clin J Pain. 1998;14(2):148-151. doi:10.1097/00002508-199806000-00010.
Mekhail N, Costandi S, Nageeb G, Ekladios C, Saied O. The durability of minimally invasive lumbar decompression procedure in patients with symptomatic lumbar spinal stenosis: Long-term follow-up [published online ahead of print, 2021 May 4]. Pain Pract. 2021;10.1111/papr.13020. doi:10.1111/papr.13020
Friedly JL, Comstock BA, Turner JA, et al. Long-Term Effects of Repeated Injections of Local Anesthetic With or Without Corticosteroid for Lumbar Spinal Stenosis: A Randomized Trial. Arch Phys Med Rehabil. 2017;98(8):1499-1507.e2. doi:10.1016/j.apmr.2017.02.029
Pope J, Deer TR, Falowski SM. A retrospective, single-center, quantitative analysis of adverse events in patients undergoing spinal stenosis with neurogenic claudication using a novel percutaneous direct lumbar decompression strategy. J Pain Res. 2021;14:1909-1913. doi: 10.2147/JPR.S304997
Pryzbylkowski P, Bux A, Chandwani K, et al. Minimally invasive direct decompression for lumbar spinal stenosis: impact of multiple prior epidural steroid injections [published online ahead of print, 2021 Aug 4]. Pain Manag. 2021;10.2217/pmt-2021-0056. doi:10.2217/pmt-2021-0056
Abstract presented at: American Society of Pain and Neuroscience Annual Conference; July 22-25, 2021; Miami Beach, FL.
Mobility Matters: Low Back Pain in America, Harris Poll Survey, 2022. View data and full summary at knowyourbackstory.com.