Vertos Medical Blog

In My Practice—Redefining the Role of Epidural Steroid Injections & the mild® Procedure

Author— Alexander Escobar, MD May 5, 2021

As pain physicians, we are well known for administering epidural steroid injections (ESIs) to manage symptoms for our patients who are suffering with lumbar spinal stenosis (LSS). They are a staple in our practices. Our colleagues know that they can confidently refer their patients to us for a series of injections, and patients know to come to us if they want to exhaust conservative options prior to considering major surgery. However, as our specialty evolves and advanced interventional therapies like the mild® Procedure secure a key role in our patient care paths, we must force change in our practice routines. This includes informing the patients and providers that we have options that allow us to move beyond serial ESIs that will address the underlying pathology and actually fix the problem.

LSS is a degenerative condition, typically with multiple spinal comorbidities having both ischemic and radicular components. ESIs help to alleviate radicular and inflammatory components while the mild® Procedure provides a minimally invasive decompression to address the ischemia or narrowing. So how do we use these therapies together? How do we develop practice treatment algorithms or patient care paths to optimize care and outcomes?

After years of treating patients with both, I ASSESS. EDUCATE. ADAPT.

ASSESS: Should you move straight to the mild® Procedure or perform an epidural steroid injection (ESI)? Assess patient history and outcomes.

Start by assessing the patient’s history and align your treatment plan with the type of relief they are seeking. Respond to their relief requests by discussing the applicable therapies that your practice offers.

Physician taking notes while speaking with an LSS patient

EDUCATE: What makes your care different than other providers? Inform patients on their condition and treatment options and give them hope, and a reason to return to your practice.

Physician examining a model of lumbar spinal stenosis

ADAPT: Is the treatment effective and meeting the patient’s expectations? Adapt to patient outcomes and situations that may arise to optimize their care.


Dr. Alexander Escobar

About Dr. Alexander Escobar
Alexander Escobar is an Anesthesiologist and Interventional Pain Physician Fellowship trained in Pain Medicine at the Cleveland Clinic with board certifications in Anesthesia and Pain Medicine. Dr. Escobar currently serves as the Clinical Assistant Professor of Anesthesiology and Pain Medicine at The University of Toledo, where he trains residents and fellows, as well as Co-Medical Director at Comprehensive Centers for Pain Management in Ohio. Dr. Escobar is a member of the American Society of Pain & Neuroscience (ASPN), American Society of Anesthesiologists (ASA), North American Neuromodulation Society (NANS), Ohio Society of Interventional Pain Physicians (OHSIPP) and American Society of Interventional Pain Physicians (ASIPP).


The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of Vertos Medical. This material is provided for guidance and/or illustrative purposes only and should not be construed as a guarantee of future results or a substitution for legal advice and/or medical advice from a healthcare provider. This material is provided for general educational purposes only and should not be considered the exclusive source for this type of information. Vertos Medical does not practice medicine and assumes no responsibility for the administration of patient care. At all times, it is the professional responsibility of the practice or clinical practitioner to exercise independent judgment. Results may vary.

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