Vertos Medical Blog

Identifying & Educating mild® Patients – APP Guidance

Published January 4, 2022

Does your practice offer the mild® Procedure? Do you manage patient identification and education? Follow these 3 steps to optimize your practice routine:

1. Start with the Symptoms

ID Shopping Cart Syndrome

Shopping Cart Syndrome – lumbar spinal stenosis (LSS) with neurogenic claudication (NC). These patients will often be the first ones to find chairs in your waiting room or use the walking aids, such as a shopping cart, to establish a flexed position. The flexed posture is a common sign of NC because it opens up the spinal canal to alleviate the pressure on the central canal to avoid pain that comes with being straight, upright, or mobile.

Silhouettes of four individuals: A man hunched over with lower back pain, a woman walking with pain in her upper legs, an elderly person holding a shopping cart to alleviate lower back pain, a person sitting to relieve back pain.

Ask patients

Ask patients the following questions to better understand how LSS with neurogenic claudication is limiting their mobility and when they experience symptom onset. Patients commonly report pain, so it is essential to talk about their functional limitations (eg, desire to walk the dog, get the mail, play with their grandchildren, etc.).

Consider incorporating these questions into your EMR or intake process so patients are routinely screened for neurogenic claudication.

Large question mark icon

  • How does your pain disrupt your life?
  • How long can you stand before you need to rest?
  • How far can you walk before you need to rest?

Ask patients

Ask patients the following questions to better understand how LSS with neurogenic claudication is limiting their mobility and when they experience symptom onset. Patients commonly report pain, so it is essential to talk about their functional limitations (eg, desire to walk the dog, get the mail, play with their grandchildren, etc.).

Consider incorporating these questions into your EMR or intake process so patients are routinely screened for neurogenic claudication.

Large question mark icon

  • How does your pain disrupt your life?
  • How long can you stand before you need to rest?
  • How far can you walk before you need to rest?

2. Confirm Candidacy:

Look for the ligament

Hypertrophic ligamentum flavum (HLF) contributes up to 85% of spinal canal narrowing

Hypertrophic ligamentum flavum (HLF) >= 2.5mm

What to look for?

  • LSS at levels L1-S1
  • Hypertrophic ligamentum flavum (HLF) – 2.5mm is the starting point

Need additional help establishing comfort with imaging review?

  • View the CME course on reading MRIs hosted by Advanced Practice Providers (APPs) Ashley Comer, NP-C; Christine Christensen, MSN, APRN; and Zohra Hussaini, MSN, FNP-BC, MBA, APRN
  • Contact your Vertos representative to set up an onsite or virtual educational session

If HLF is present, confirm candidacy…even in patients with comorbidities. mild® is an option for a broad spectrum of patients.

Candidates may have:

Medical comorbidities:

  • Osteoporosis
  • BMI >40

Spinal comorbidities:

  • Grade 1-2 spondylolisthesis
  • Foraminal narrowing
  • Degenerative disc disease
  • Lateral recess narrowing

Confirm coverage

mild® is covered by Medicare (all ages, all plan types, including Medicare Advantage), the VA, U.S. Military, and IHS. Commercial coverage varies.

3. Educate Patients & Establish Appropriate Outcomes and Expectations

Educate early – move to mild® after the first ESI fails

Illustration of a syringe with text label: "Safety profile similar to an ESI." Second illustration shows the size of the incision with text label: "No implants left behind, only a Band-Aid."

Establish appropriate outcomes and expectations

mild® helps patients stand longer and walk farther with less pain.

Infographic titled "Increased Mobility Over Time."  The infographic shows a graph indicating how a person's standing time improves 7x over the 12 months following the mild® procedure.  The second graph shows that a person can walk 16x farther after 12 months following the mild® procedure.

Optimize outcomes with reconditioning

Illustration of a person walking. Caption says: "Patients typically resume normal activity within 24 hours with no restrictions. Functionality improves over time."

  • At-home reconditioning walking program can be initiated immediately, as tolerated
  • Assess outcomes at 2-weeks and 4-6 weeks, then monthly. Assess mobility and Quality of Life (QOL) improvements, such as:
    • Transfer ability: Getting in and out of the bed/seat/car
    • Walking and standing times
    • Activities of daily living: Ability to get dressed, take off shoes, household chores, and grocery shopping

Optimize outcomes with reconditioning

Illustration of a person walking. Caption says: "Patients typically resume normal activity within 24 hours with no restrictions. Functionality improves over time."

  • At-home reconditioning walking program can be initiated immediately, as tolerated
  • Assess outcomes at 2-weeks and 4-6 weeks, then monthly. Assess mobility and Quality of Life (QOL) improvements, such as:
    • Transfer ability: Getting in and out of the bed/seat/car
    • Walking and standing times
    • Activities of daily living: Ability to get dressed, take off shoes, household chores, and grocery shopping

Illustration of a shopping cart explaining how "Shopping Cart Syndrome" is a sign of a patient suffering from lumbar spinal stenosis (LSS) with neurogenic claudication.

An image of a shopping cart that provides details about comorbidities and candidate eligibility for the mild® Procedure.

Illustration of a shopping cart explaining how "Shopping Cart Syndrome" is a sign of a patient suffering from lumbar spinal stenosis (LSS) with neurogenic claudication.

An image of a shopping cart that provides details about comorbidities and candidate eligibility for the mild® Procedure.

If you would like a mild® Quick Reference Card for your office or to learn more about APP-specific educational opportunities, please contact us and let us know what you need.

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