Lumbar Decompression Relieves Spinal Stenosis Pain More Than Epidural Injection
Source— Pain Medicine NewsNovember 1, 2019
This one-page Pain Medicine News article states that, “Minimally invasive lumbar decompression (mild®) reduced back pain caused by lumbar stenosis, and decreased opioid use, in patients far more effectively than epidural steroid injection (ESI),” according to a study. Findings from that study were presented in a research poster by sole author Navdeep Singh Jassal, MD, at the 2019 annual meeting of the American Society of Interventional Pain Physicians.
Dr. Jassal explains that although, “epidural injections are efficacious to treat acute radiculopathy, a pain that is caused by an inflammatory condition, lumbar spinal stenosis (LSS) is caused by compression of the nerve roots, and the only effective way to treat it is to decompress the spine.” Detailing the study, the article states that it “included 33 patients with a mean age of 77.9 years, who were treated with mild® between February 2018 and January 2019, at a single center. All patients had presented with moderate to severe central stenosis, including lumbar ligamentum flavum hypertrophy, as well as facet hypertrophy and degenerative disk disease, and 82% had presented with foraminal stenosis. They had failed conservative treatment, including at least one epidural steroid injection per patient.”
Benyamin, R., et al. (2016), mild® is an Effective Treatment for Lumbar Spinal Stenosis with Neurogenic Claudication: MiDAS ENCORE Randomized Controlled Trial, Pain Physician, 19: 229-242, ISSN 1533-3159.
Mekhail, Nagy, et al. (2012) Functional and Patient-Reported Outcomes in Symptomatic Lumbar Spinal Stenosis Following Percutaneous Decompression. Pain Practice, 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, et al. for the MiDAS ENCORE Investigators. (2018), 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.
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., et al. (2020), Minimally invasive lumbar decompression: a review of indications, techniques, efficacy and safety, Pain Manag., Published online ahead of print: 1 Jul 2020, https://www.futuremedicine.com/doi/10.2217/pmt-2020-0037.
Deer, TR, Grider, JS, Pope, JE; For the Lumbar Spinal Stenosis Consensus Group. (2019) The MIST Guidelines: The Lumbar Spinal Stenosis Consensus Group Guidelines for Minimally Invasive Spine Treatment. Pain Pract. 2019;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-
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.
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