Pain Medicine News Article: PILD and Open Decompression for the Treatment of Lumbar Spinal Stenosis, 2-Year Outcomes
Source— Pain Medicine News Published August 7, 2023
In a recent Pain Medicine News multimedia feature article, Dr. Peter Staats, chief medical officer of the National Spine and Pain Centers, discussed data from his award-winning Top Abstract 2023 at the American Society of Pain and Neuroscience’s (ASPN) 5th annual conference in Miami Beach, FL.
Dr. Staats and his team analyzed a Medicare data set between 2017 and 2019 that included patients who had neurogenic claudication with spinal stenosis and underwent a surgical procedure: either the mild® Procedure or an open laminectomy. They showed that the incidence of harms in the open laminectomy arm was significantly greater compared with the mild® Procedure. Dr. Staats noted, “We all go down the path of trying to treat our patients as conservatively as we can with safety first, and this is clearly demonstrating to be a safer approach.”
In the below video, Dr. Staats discusses his abstract and the conclusions drawn from it. To read more in depth about Staats’ abstract, please visit our blog post, “An Overview of mild® Procedure Abstracts Showcased at the ASPN 2023 Annual Conference.”
Click to Read the Full ArticleTranscript:
(00:00) Hi, I’m Peter Staats. I’m a Pain Medicine advisory board member. I’m also Chief Medical Officer of National Spine and Pain Centers. I’m a long-time Interventional Pain Physician, having been around the space for a little while. I’m thrilled to receive one of the top abstracts at the American Society of Pain and Neuroscience.
(00:32) Our abstract looked at an entire Medicare data set between 2017 and 2019 for patients who had neurogenic claudication with spinal stenosis who had to go up through a surgical procedure, either a mild® Procedure or an open laminectomy.
(00:52) What we showed is that the incidences of harms in the open laminectomy arm was significantly greater. Harms would be things like a wound infection or a dural tear or something that causes the patient some kind of injury.
(01:11) The flip side of that is that there was about a 3-4% increase in the incidence of needing to have a subsequent surgical procedure in the group that underwent the mild® Procedure. So, putting it all together, I think that this starts to really give us a treatment algorithm. We all go down the path of trying to treat our patients as conservatively as we can with safety first, and this is clearly demonstrating to be a safer approach.
(01:40) However, we haven’t lost anything. If the patient doesn’t do well with the mild® Procedure, an open laminectomy is still an option for the patients.
The views and opinions expressed in this article are those of the authors/speakers and do not necessarily reflect the official policy or position of Vertos Medical.
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.
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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.
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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.
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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 here.
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.