Pain Management Strategies for Lumbar Spinal Stenosis
March 26, 2021
Did you know… you don’t have to live with back pain associated with lumbar spinal stenosis? More than two million patients nationwide are diagnosed with lumbar spinal stenosis annually, but not all of them know about the treatment options available to relieve their pain. Here, we break down some of the options and methods available, and help you understand if the mild® Procedure might be right for you.
What is Lumbar Spinal Stenosis?
Best visualized as a kink in a drinking straw, lumbar spinal stenosis is a condition in which the lower spinal canal narrows and compresses the spinal nerves in the lower back. Lumbar spinal stenosis usually develops slowly over time. It can be genetic or related to a condition present at birth, but is most often a degenerative condition. It’s prevalent in ~20% of patients aged 60+, so if you have lumbar spinal stenosis, you are not alone. It’s most common cause is natural, degenerative changes in your spine as you age. And it can get painful, quick.
Pain or numbness in the lower back when standing upright
Pain, numbness, heaviness or tingling in upper legs or buttocks when walking
Pain when lying down that may be relieved by curling into the fetal position
Those with lumbar spinal stenosis may experience temporary relief when bending forward while sitting or standing as pressure on the spinal cord is released and space in the spinal canal is “opened.” Common actions to relieve your pain may include sitting in a chair, leaning over a shopping cart, or using a walker or cane.
One common misconception is that back pain is part of aging and cannot be avoided or treated. However, it’s helpful to know, there are specialized interventional pain doctors who are trained to help patients find long term relief from chronic back pain, like that associated with lumbar spinal stenosis. So, rather than avoiding exercise and activity that trigger your back pain, it is encouraged that you schedule an appointment with a doctor who can help.
How Do I Know if I Have Lumbar Spinal Stenosis?
Only a doctor can truly diagnose the condition, but there is a quick self assessment that can help you provide your doctor with the right information about your symptoms.
Place your feet shoulder width apart and stand in place
Start timing how long you can stand still without pain
Stop timing when you need to rest, sit down or lean forward for relief
Note your time and the symptoms you experience to discuss with your doctor
Your doctor will review your medical history and symptoms, and diagnose lumbar spinal stenosis with imaging that may include an MRI, X-Rays or a CT scan. Then, they will review the best treatment options for you.
Armed with the right information, your doctor will typically offer treatment options based on their safety profile. If you seek care from a specialized interventional pain doctor, they will generally offer conservative treatments and minimally-invasive procedures in an effort to avoid surgery.
The first course of action may be conservative treatments like over-the-counter pain medication, physical therapy or chiropractic care. While their safety profile may be low, these treatments aren’t always effective for everyone.
Epidural Steroid Injections
If the pain is still present, your doctor may recommend an epidural steroid injection (ESI). These injections typically bring relief, but often, that relief is only temporary. If long-term relief doesn’t come after your initial ESI, consider the mild® Procedure as your next step.
What is the mild® Procedure?
mild® stands for minimally invasive lumbar decompression. The mild® Procedure addresses a major root cause of lumbar spinal stenosis by removing small pieces of bone and thickened ligament. This restores space in the spinal canal, which reduces the compression of the nerves, or “removing the kink in the drinking straw.” mild® typically takes less than an hour and can be performed through a single, tiny incision smaller than the size of a baby aspirin (5.1 mm). The mild® Procedure has a safety profile similar to that of an epidural steroid injection, but with lasting results, and patients typically resume normal activity within 24 hours with no restrictions.
Does the mild® Procedure Work?
mild® has been performed on thousands of patients to provide lasting pain relief and increased mobility. mild® has demonstrated excellent long-term durability with significant improvements in both pain and mobility. In a one-year study performed by the Cleveland Clinic, mild® patients were able to increase their average walking distance from 246 feet to 3,956 feet and their standing time from 8 minutes to 56 minutes with less pain.
What do mild® Patients Say?
“After the procedure, I had no pain whatsoever. I could walk, I could go up and down the stairs, I could get in and out of the car. I mean, I felt great.” Dante Lavino, mild® Patient
“My friends and family can’t believe the difference in what I am doing now since I had the mild® Procedure. Grandma is back to cookin’!” Lynn Ballard, mild® Patient
“It just changed everything… before I’d say ‘Man, I wish I could’ but now I say ‘count me in, you know I’m ready.’” Ronnie Turner, mild® Patient
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.