How Do You Describe the mild® Procedure to Your Lumbar Spinal Stenosis Patients?
January 31, 2022
mild® is often referred to as a “simple little procedure” that can make a major impact on the quality of life and mobility for lumbar spinal stenosis (LSS) patients. Minimally invasive lumbar decompression (mild®) removes the problem and leaves nothing behind—no implants, no stitches—allowing patients to stand longer and walk farther with less pain. A short, outpatient procedure, it is performed through a single 5.1mm incision in the patient’s lower back, addressing a major root cause of lumbar spinal stenosis by removing excess ligament tissue. Patients typically resume normal activity within 24 hours with no restrictions.
So, how do practices describe this “simple little procedure” to their patients? We like to say the mild® Procedure is similar to “removing a kink in a drinking straw,” reducing the compression on the nerves in the lower back to restore mobility and relieve pain.
We asked a group of mild® physicians how they describe the mild® Procedure and its big, life-changing potential to their patients and referring physicians. We heard a lot of fun analogies—here are a few of our favorites.
ESI is like
mild® is like
Dr. Peter Pryzbylkowski; Linwood, NJ
I describe mild® to my patients as a “quality-of-life procedure.”
I walk them through my algorithm and I say, “Listen: I can put a temporary Band-Aid [solution] on this for you with an epidural steroid injection (ESI), or I have a tool in my toolkit that could hopefully fix this for you where it’s not just a Band-Aid. It really improves your quality of life.”
Once you frame it this way for patients—as an epidural being a Band-Aid, with mild® being more of a definitive procedure—you have a captive audience that typically wants to go ahead and get a percutaneous decompression.
For patients who know cardiology, ESI is like
mild® is like
Dr. Brian Durkin; Port Jefferson, NY
Our patients are generally familiar with cardiology procedures. So, I tell them lumbar spinal stenosis treatment options are similar to the options available for patients with coronary artery stenosis. You can either treat them with meds to improve blood flow or put in a stent to open it up more permanently. The mild® Procedure restores space around the spinal cord, just like a stent restores space in your blood vessels.
ESI is like
mild® is like
Dr. Brian J. Goentzel; Wichita, KS
I tell patients: “Your spinal canal is kind of like your sink when it gets clogged. If your sink is really clogged, you can pour Drano down it all you want. But that’s a temporary fix, and it doesn’t work long-term. At some point, you’ve got to get in and unclog the drain.”
ESI is like
mild® is like
Dr. Erin Chaney; Jacksonville, NC
I describe how mild® works like fixing a room that is overcrowded with furniture. I tell them:
“Imagine a room full of tables and chairs, and you just can’t move around. What I am going to do today is just take a couple of chairs out to make some more space, so your anatomical structures can move around easily.”
LSS is like
mild® is like
Dr. Dawood Sayed; Kansas City, KS
“When I describe what stenosis/LSS does to a patient’s spinal canal, I compare it to having too many people in an elevator. What we do with mild® is open the door and let a few people out so that the folks remaining have more room to move freely for the ride.”
How do you describe mild® to your patients? If you have an effective analogy you use to talk about the benefits of mild® or its approach, we’d love to hear about it. Email us today. If you need additional patient resources, please contact your Vertos representative.
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.
Deer TR, Grider JS, Pope JE, et al. Best Practices for Minimally Invasive Lumbar Spinal Stenosis Treatment 2.0 (MIST): Consensus Guidance from the American Society of Pain and Neuroscience (ASPN). J Pain Res. 2022;15:1325-1354. Published 2022 May 5. doi:10.2147/JPR.S355285.