View South Central Regional Medical Center’s recent HealthBreak segments featuring the mild® Procedure for lumbar spinal stenosis.
SCRMC HealthBreak Segment
mild® Procedure — Posted February 27, 2023
Over 2 million people are diagnosed with lumbar spinal stenosis annually. Spinal stenosis usually presents with lower back pain when standing up straight, an aching sensation, numbness, and tingling and pain in buttocks when patients are walking. Dr. Rayhan Tariq, Interventional Pain Management physician, offers an alternative to open spine surgery known as mild® — minimally invasive lumbar decompression.
Deborah Butler’s pain was at a level 9 by the time she found help at South Central Pain Center. Mrs. Butler said, “I woke up and my hip, all the way down to my knee, was in horrible pain.” After meeting with various physicians and trying physical therapy, Mrs. Butler contacted Dr. Tariq to discuss alternative treatments. Together, they made the decision to perform the mild® Procedure on Mrs. Butler. Today, she states, “My pain level has decreased to a level 2, and I have regained my quality of life.”
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.
Original Publish Date: Jan 19, 2023 Contributing Writer for Novant Health: Page Leggett
“Patient enjoys shopping and traveling again without having major surgery”
Article Excerpts:
Sherry Clayton, 74, has always been active. Like many people her age, she had arthritis—but it didn’t keep her from doing the things she loved. Then, in June 2021, her pain became too much. An MRI revealed that she had lumbar spinal stenosis, a disease that occurs when the space inside the spine becomes too small, placing pressure on the spinal cord and nerve roots.
The condition is more common in older populations. One out of every 1,000 people over the age of 65 is likely to develop spinal stenosis, according to the National Institutes of Health (NIH).
Clayton, a resident of Fort Mill, South Carolina, saw two spine surgeons, both of whom recommended spinal fusion surgery—but even that wouldn’t guarantee she’d be pain-free. Not being one to accept the status quo, Clayton did some research. She found the website for Vertos Medical and liked what she read about the minimally invasive lumbar decompression, mild® Procedure, which led her to Dr. Nasir Khatri. He and his partner, Dr. Jacob Wang, are two of just a handful of doctors in the Charlotte area trained on the procedure. Vertos is a medical device company that manufactures the specialized equipment necessary to perform the procedure.
About six weeks after her initial consultation with Khatri, Clayton went to Novant Health Presbyterian Medical Center—the very hospital where she was born—to have the same-day procedure. Khatri reported: “At her two-week follow-up appointment, she reported having nearly 75% pain relief and, more importantly, improved function. Based on her Apple Watch data, she is now walking double the steps she could before.”
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.
Congratulations to Nicole Arnold, our Director of Human Resources, who was recently recognized as one of the Orange County Business Journal’s Distinguished Leaders: Human Resources 2023. The annual list honors HR leaders who have navigated the ever-changing HR landscape and demonstrated an impact within their organization and the Orange County community.
Nicole Arnold has brought significant improvements to our organization’s performance during her tenure. She has implemented various initiatives to strengthen our team and keep morale in check. Firstly, she led the extraction of a comprehensive People Experience Organization (PEO) for HR functions and onboarding to our own Human Capital Management system, all while building the HR team and functions from bottom up. Furthermore, she ensured that our employees were always at the forefront of every decision, offering strategic advice and advocating employee benefits, while also finding ways of streamlining processes and improving morale. We are grateful for her dedication and contributions.
Could Knowing Your “Back Story” Help You Rewrite Your Future?
Vertos Medical is proud to have joined forces with the American Society of Pain & Neuroscience (ASPN) and the National Association of Memoir Writers (NAMW) to develop the Know Your Back Story campaign, a national public health awareness campaign that seeks to help patients suffering from chronic low back pain (CLBP) learn more about their “back stories.” The campaign encourages providers to educate their patients on lumbar spinal stenosis (LSS) and provide awareness around the enlarged ligament that may be causing their pain.
Vertos Medical is committed to empowering healthcare providers and patients with minimally invasive treatments for LSS, and the Know Your Back Story campaign plays a significant role in fulfilling our core mission: to help patients suffering from chronic back pain reclaim their quality of life using the simplest, safest, most durable, and earliest treatment available.
The Prevalence of Chronic Low Back Pain
As part of the Know Your Back Story campaign, we partnered with The Harris Poll to conduct a landmark survey on CLBP in the United States. Results from the “Mobility Matters: Chronic Low Back Pain in America” survey indicate that CLBP affects more people than arthritis, diabetes, or heart disease, but over one-third of CLBP patients have never been told by a provider what the exact cause of their pain is.
The Need for Increased Patient Education
“Mobility Matters: Landmark Survey on Chronic Low Back Pain in America” also revealed misconceptions about CLBP and the need for education about the associated impacts on mobility and quality of life, and where to go to for diagnoses and information about available treatment options.
Finding the Right Doctor
The average chronic low back pain sufferer has seen at least 3 different healthcare professionals (HCPs) seeking treatment for their pain and has made 4 visits to an HCP within the last year.
For the most accurate diagnoses and treatment recommendations that may lead to lasting relief, patients should seek out doctors who specialize in spine health, such as pain specialists, physical medicine, and rehabilitation (PM&R) physicians, interventional pain physicians, or physiatrists.
By meeting with doctors who specialize in spine health, patients may be able to gain new insights into the root cause of their pain.
LSS: The Often-Overlooked Cause of CLBP
Lumbar spinal stenosis (LSS) is a condition, prevalent in approximately 20% of patients over the age of 60, in which the lower spinal canal narrows and compresses the nerves in the lower back. Up to 85% of spinal canal narrowing is caused by an enlarged ligament.
This pressure around the spinal cord can cause pain, numbness, heaviness, or tingling in the low back, legs, and buttocks, but the vast majority of CLBP patients have never heard of this potential diagnosis.
The Know Your Back Story campaign’s objective is to spread awareness around LSS and get more patients on the path to lasting relief. By collecting intensive data, developing tools for patient education, and sharing insights with both patients and providers about the effects of LSS and its potential treatment options, the Know Your Back Story campaign has served as a significant step in bringing more visibility to this condition.
Get To Know Your Back Story
Getting screened for LSS and CLBP can open the door to learning more about treatment options available, such as the mild® Procedure.
Introducing the First-Of-Its-Kind Mobility Index
One of the key accomplishments of the Know Your Back Story campaign is the development of the first-ever Mobility Index, a breakthrough resource for demonstrating the differences in mobility and quality of life between patients with CLBP and their peers without CLBP.
Results from the “Mobility Matters: Landmark Survey on Chronic Low Back Pain in America” conducted by The Harris Poll show that with age, CLBP patients experience significantly greater challenges performing physical tasks and making it through the day without pain or limited mobility than others within their age group without low back pain.
For instance, nearly 3 in 4 individuals in their 50s who do not suffer from CLBP are able to easily stand for half an hour or longer. In contrast, the number of CLBP patients in the same age range who are able to do the same is just over 3 in 10.
When it comes to other activities such as walking, dancing, or using the stairs, the Mobility Index can be a great tool for educating patients. By reviewing the differences in mobility between similar individuals with and without CLBP, patients can understand more about what chronic pain is keeping them from—and their options for finding lasting relief.
Bringing the Know Your Back Story Campaign to the Public
On the quest to educate, engage, and increase awareness within communities, the Know Your Back Story campaign took the #LookForTheLigament Education and Experiential Mobile Unit on tour down the East Coast, stopping in New York City, NY; Philadelphia, PA; Washington, D.C.; and Sarasota, West Palm Beach, and Miami, FL.
The mission of this tour was to encourage people suffering from CLBP to get screened for LSS and an enlarged ligament by a spine health doctor, and to provide both patients and HCPs with an in-depth look at the causes and effects of LSS through interactive experiences and demonstrations, including:
Visualization stations that explored why LSS symptoms occur, tips on how to identify symptoms, how an enlarged ligament impacts spine health, and the potential for the mild® Procedure as a treatment option.
An immersive 3D journey down the spinal canal to the lumbar region that explored the enlarged ligament, spine degeneration, and how mild® works.
The Interactive Ligament Kiosk, which featured Mobility and the Enlarged Ligament, an animated educational program that demonstrated the inherent spinal compression associated with the diagnosis of LSS and its effect on pain, posture, and mobility; a Look for the Ligament interactive opportunity for people to view and compare MRI images of how a healthy ligament should look against imaging of an enlarged ligament; and a How Do Doctors Describe LSS? module filled with a colorful list of analogies and explanations doctors often use to describe the condition to their patients.
Interactive Motion MemoiriPads, featuring our writing program developed with award-winning author, certified therapist, and founder of the National Association of Memoir Writers (NAMW), Dr. Linda Joy Meyers, who provided tips and encouragement to help patients trace their own history of low back and leg pain to visualize the next chapter of their potentially pain-free life.
Watch the Video to See More Highlights From the #LookForTheLigament Tour:
Getting Involved as a Healthcare Provider
By staying aware of the impacts of LSS and CLBP on patients’ mobility and potential treatment options, healthcare providers can help more patients in their communities get on the path to lasting relief. By working alongside others in their practice or by creating referral networks with primary care, physical therapy providers, and other local providers, HCPs in Interventional Pain Management (IPM) or spine health specialties can play a more effective role in identifying patients suffering with LSS or CLBP and connect them to providers that are able to offer more durable treatment options.
Physicians and Advanced Practice Providers (APPs) can also play a more proactive role in identifying LSS by staying aware of common patient misconceptions about back pain. By utilizing the tools and resources developed as part of the Know Your Back Story campaign, you can keep your patients as educated as possible about the potential causes of their chronic pain, as well as the treatment options that may finally provide them with relief.
Hear From Patients
How Patients Can Find Relief
For patients looking to learn more about the source of their pain and their options for relief, finding a local spine health doctor is a crucial first step. By using the MD Finder tool, patients can find doctors in their area who may be able to provide the answers they’ve been seeking.
A spine health specialist can help walk patients through their options for treatment, from more conservative therapies such as medication or physical therapy to longer lasting, minimally invasive treatments such as the mild® Procedure.
How mild® Makes a Difference
The mild® Procedure, or minimally invasive lumbar decompression, may be pursued as a first-line therapy for LSS.
A minimally invasive procedure that is considered the gold standard of care in LSS treatment, mild® addresses a major root cause of LSS by debulking the enlarged ligament to restore space in the spinal canal and reduce compression of the nerves. With a safety profile equivalent to an epidural steroid injection (ESI), mild® has helped 88% of patients avoid back surgery for at least 5 years while providing lasting relief,—a durable, lower-risk treatment option to spacer implants or open surgery.
For patients considering mild®, the Move More Questionnaire is a great resource for identifying current limitations and tracking their reduced pain and improved mobility after the procedure.
By becoming familiar with the Know Your Back Story campaign and exploring the insights and resources developed to spread awareness about LSS, both patients and providers can help spread the word about this under-diagnosed cause of CLBP.
Vertos Medical is committed to helping patients experiencing chronic pain reclaim their quality of life with a short, minimally invasive early treatment option with the mild® Procedure, both through the Know Your Back Story campaign and in everything we do.
We’re proud to highlight Ashley Comer, A.P.R.N., NP-C, on her educational Op-Ed article in the Charleston Gazette! As a member of our Advanced Practice Provider (APP) Advisory Board and as a nurse practitioner working within Interventional Pain Management (IPM), Ashley interacts daily with patients suffering from chronic low back pain (CLBP), many of whom are simply searching for relief.
Data from a recent Harris Poll survey found that nearly 3 out of every 10 US adults currently suffer from CLBP, and over a third of those surveyed rated their back pain as “severe.” Many of these individuals visited multiple doctors, and while their pain progressed, only then considered seeing an Interventional Pain Specialist.
Read Ashley’s insights below on why patients should consider IPM at the onset of pain treatment and potential treatment options outside of the often-prescribed opioids.
For Coding, Coverage and Reimbursement support, click here.
If you are an Advanced Practice Provider (APP) searching for educational content for yourself or your peers, you are in the right place. Review our APP-developed resources on all topics related to lumbar spinal stenosis, imaging review, patient management and the mild® Procedure.
Identifying & Educating mild® Patients
Follow 3 easy steps to optimize your practice routine regarding symptoms, candidacy, and expectations.
If you experience chronic low back pain (CLBP), you may have questions: What’s causing it? What do my symptoms mean? Will my condition worsen as I age? How can I find relief?
You’re looking for answers—and you’re not alone. Unlike other debilitating conditions, researchers have never truly known how many people suffer from CLBP. Until recently, many patients have been left in the dark about the cause of their pain or their options for treatment.
As revealed in the Mobility Matters: Landmark Survey on Chronic Low Back Pain in America, created in partnership with The Harris Poll, there are many misconceptions about chronic low back pain, including its potential causes, symptoms, and treatment options.
Before this survey, we didn’t know which patients were suffering the most, or how the CLBP experience may change through life’s decades. In this blog, we’ll share the results of the survey, explore a common, yet often undiagnosed, cause of CLBP, and discuss some of the treatment options available for patients seeking relief.
As we grow older, it can be difficult to assess which mobility challenges are a normal part of aging, and which ones may indicate a condition such as CLBP. The Mobility Index, developed as part of the national Know Your Back Story campaign, was designed to demonstrate how older adults could be moving through life if chronic low back or leg pain was not a limiting factor.
Through the Decades: How DoesYour Mobility Measure Up?
Poll results show that with age, CLBP patients experience significantly greater challenges performing physical tasks and making it through the day without pain than their peers who do not suffer from low back pain.
What Could You Do With Fewer Limitations?
If you’re suffering from CLBP, you’re already familiar with the limits your pain can put on daily tasks and activities. But do you know just how much you could be doing without these obstacles?
Mobility In Your 50s
For CLBP patients in their 50s, having difficulty doing physical activities that were once a regular part of life, such as walking a mile or dancing for the duration of one song, can feel especially discouraging.
Mobility In Your 60s
For people in their 60s, there are some activities like—jogging—that aren’t for everyone. Even among individuals without CLBP, only 50% of respondents in their 60s reported the ability to jog with ease. However, for patients suffering with chronic low back pain, this number plummets to only 13%.
And whether jogging, walking, or doing anything else, fewer than half of CLBP patients in their 60s say they feel satisfied with how their body gets around. In contrast, 80% of 60-somethings without CLBP are satisfied with their mobility.
Mobility In Your 70s
Did you know that 80% of people in their 70s without CLBP are able to easily go up and down the stairs? If you are a CLBP sufferer in your 70s, you may have a much different experience, as fewer than half of CLBP patients in their 70s reported the same mobility using stairs.
Getting up from the floor is another activity that impacts CLBP sufferers much more than their peers who don’t experience chronic pain. While 66% of 70-somethings without CLBP reported ease in getting up or down from the floor, only 28% of those with CLBP were able to say the same.
Could An Enlarged Ligament Be Causing Your Low Back Pain?
One cause of low back pain that often goes undiagnosed is an enlarged ligament, which can contribute to lumbar spinal stenosis (LSS), a common, yet overlooked, condition that millions of people may be unaware of.
What Is Lumbar Spinal Stenosis?
Lumbar spinal stenosis (LSS) is a common, yet overlooked, condition that is prevalent in nearly 20% of patients over the age of 60.
LSS is often caused by an enlarged ligament in the back, which compresses the space in the spinal canal and puts pressure on the nerves in the lower back. This pressure around the spinal cord can cause pain, numbness, heaviness, or tingling in the low back, legs, and buttocks.
How CLBP Impacts Daily Life
Unsurprisingly, the chronic low back pain that may be caused by LSS has negative impacts on nearly every aspect of a patient’s life, most commonly in their abilities to exercise, stand or walk for long periods of time, and get a good night’s sleep.
Low Back Pain & LSS Treatments
Due to its minimally invasive nature and long-lasting durability, many interventional pain management doctors are making the move to mild® as an alternative to epidural steroid injections (ESIs), which may only work in the short-term and may require repeat injections to maintain relief.
More invasive courses of treatment can include procedures such as spacer implants or open surgery, though nearly 80% of CLBP sufferers have concerns about undergoing surgery.
The mild® Procedure, or minimally invasive lumbar decompression, is considered a gold standard of care among treatments for low back pain. By addressing the root cause of pain, the enlarged ligament, mild® has helped 88% of patients avoid back surgery for at least 5 years while providing lasting relief.
For Many Sufferers of CLBP, It Doesn’t Just Go Away On Its Own.
If you’re looking for answers about your chronic low back pain, a spine health doctor can help you determine the cause and provide you with treatment options that fit your needs.
When patients present complaining of chronic low back pain (CLBP), they’re relying on you, as their provider, to help them find answers. Many patients want to know what’s causing their pain, how their condition will progress over time, and perhaps most importantly, how they can find relief.
As revealed in the Mobility Matters: Landmark Survey on Chronic Low Back Pain in America,created in partnership with The Harris Poll, many CLBP patients feel that they have been left in the dark about the cause of their pain or their options for treatment; as a provider, you’re all too familiar with the challenges and frustrations that can come with chronic pain.
In this blog, we’ll share some of the results of the groundbreaking survey, including new insights into how CLBP can impact patients’ lives as they age. We’ll also explore a common, though often undiagnosed, cause of CLBP and discuss some of the treatment options available for patients seeking relief.
By staying informed about the causes of low back pain, educating patients about their treatment options, and encouraging patients to seek help from spine health specialists, healthcare providers can play a key role in improving patients’ quality of life.
78% of Adults With Chronic Low Back Pain Don’t Know That An Enlarged Ligament May Be the Cause.
One cause of CLBP that often goes undiagnosed is an enlarged ligament in the lower back, which can contribute to lumbar spinal stenosis (LSS). LSS is a common, yet overlooked, condition that is prevalent in nearly 20% of patients over the age of 60.
LSS is often caused by an enlarged ligament in the back, which compresses the space in the spinal canal and puts pressure on the nerves in the lower back. This pressure around the spinal cord can cause pain, numbness, heaviness, or tingling in the low back, legs, and buttocks.
By recognizing the symptoms and understanding the treatment options, you may be able to identify the condition sooner in your patients with chronic low back pain and get them on the path to lasting relief.
Unsurprisingly, CLBP that may be caused by LSS has negative impacts on nearly every aspect of a patient’s life—most commonly in the ability to exercise, stand or walk for long periods of time, or get a good night’s sleep.
Introducing the Mobility Index
As patients age, it can be difficult to assess which mobility challenges are a normal part of aging, and which may have an explanation, such as an enlarged ligament.
The Mobility Index was designed to demonstrate just how different life could be for older adults if chronic low back or leg pain was not a limiting factor.
Results from the Mobility Matters survey indicate that adults with CLBP face significantly more difficulties performing physical activity and making it through the day without pain than their peers without chronic pain.
What Could Your Patients Do With Fewer Limitations?
Patients who suffer from CLBP are already familiar with the limits their pain can put on carrying out daily tasks and activities. But they may not even realize just how much they’re missing out.
When it comes to activities such as walking, dancing, using the stairs, and more, the Mobility Index can be a great tool for educating patients. By reviewing the differences in mobility between individuals with and without CLBP, you can help your patients understand more about their mobility and their options for relief.
Mobility By the Decades: 50s
For CLBP patients in their 50s, having difficulty doing physical activities that were once a regular part of life, such as walking a mile or dancing for the duration of one song, can feel especially discouraging.
Mobility By the Decades: 60s
For patients in their 60s, there are some activities—like jogging—that aren’t especially popular. Even among individuals without CLBP, only 50% of respondents in their 60s reported the ability to jog easily. However, for patients suffering with CLBP, this number plummets to only 13%.
Mobility By the Decades: 70s
80% of people in their 70s without CLBP are able to easily go up and down the stairs. But the experience may be significantly more challenging for CLBP patients of the same range, as fewer than half of those with CLBP were able to say the same.
Getting up from the floor is another activity that impacts CLBP sufferers much more than their peers who don’t experience chronic pain. While 66% of 70-somethings without CLBP reported ease in getting up or down from the floor, only 28% of those with CLBP were able to say the same.
Options for Low Back Pain & LSS Treatment
If you think lumbar spinal stenosis could be causing a patient’s low back pain, and common conservative treatment options such as physical therapy, pain medication, and epidural steroid injections (ESIs) are no longer providing adequate relief, it may be time to move to mild®.
The mild® Procedure, or minimally invasive lumbar decompression, is considered a gold standard of care among treatments for lumbar spinal stenosis. By addressing the root cause of pain, the enlarged ligament, mild® has helped 88% of patients avoid back surgery for at least 5 years while providing lasting relief.
Due to its minimally invasive nature and long-lasting durability, many interventional pain management physicians are making the move to mild® as an alternative to epidural steroid injections (ESIs), which may only work short-term and may require repeat injections to maintain relief.
More invasive courses of treatment can include procedures such as spacer implants or open surgery, though nearly 80% of CLBP sufferers have concerns about undergoing surgery.
CLBP Doesn’t Go Away On Its Own
For patients experiencing chronic low back pain, it’s never too early to act. Without addressing the root cause of pain—such as the enlarged ligament in cases of LSS—patients can often go years without finding relief.
The Know Your Back Story campaign, a national public health awareness campaign, educates and encourages millions of people with CLBP to learn more about their “back story” and encourages providers to educate patients about LSS and the enlarged ligament that may be the source of this pain.
If your patients are seeking answers for chronic low back pain, they may benefit from the mild® Procedure as a first course of treatment. By referring patients to a local interventional pain management physician, you can help get them on the path to lasting relief.
Offering decades of experience and expertise in the healthcare field, our team continues to advance minimally invasive technologies to help the millions of patients suffering from LSS return to a better quality of life.
The American Society of Pain and Neuroscience (ASPN) identified an educational need for guidance on the prudent use of the innovative minimally invasive surgical therapies for the treatment of symptomatic LSS. The executive board nominated experts spanning anesthesiology, physiatry, orthopedic surgery, and neurosurgery based on expertise, publications, research, diversity and field of practice. Evidence was reviewed, graded using the United States Preventive Services Task Force (USPSTF) criteria for evidence and recommendation strength and grade, and expert opinion was added to make consensus points for best practice. ASPN created a guidance for best practice for minimally invasive surgical treatment of symptomatic spinal stenosis. Consensus Point 6: PILD should be considered for the treatment of mild-to-moderate LSS in the presence of NC, with less than or equal to a grade 2 spondylolisthesis, and with a contribution of spinal narrowing with at least 2.5 mm of LFH. Grade A; Level of certainty high; Level of evidence 1-A.
Vertos Medical is sponsoring a national health awareness campaign to increase education around lumbar spinal stenosis and the enlarged ligament as a major cause of low back and leg pain. Let’s work together to inform your community about the mild® Procedure and what your practice has to offer.
Use these resources and assets you need to raise awareness among your provider team, patients, social media followers, and referring healthcare professionals.
Connect with us: Stay up-to-date with the latest information on the campaign and tag us in your posts! Lead people to KnowYourBackStory.com to learn more!
Incorporate these ready-to-use social media templates into your feed. Include hashtags: #KnowYourBackStory #LetsGetMoving #EnlargedLigament #mildprocedure #NationalHealthAwarenessCampaign #LookForTheLigament #PainMedicine #MOVE2mild #lumbarspinalstenosis #lss.
Host & Invite Your Colleagues & Referring Practices to an Event
JOIN US for a fun, interactive, educational experience designed to help you learn about your patients’ back story. Let’s discuss the advancements in the Interventional Pain Specialty & what is available to help your low back & leg pain patients—like the mild® Procedure.
[ENTER DATE]
[ENTER LOCATION]
Learn more at knowyourbackstory.com & message me if you would like to join!
JOIN US for a fun, interactive, educational experience designed to help you learn about your own back story. Speak to our staff, hear from others who have found relief from low back & leg pain, & find out if the mild® Procedure could be right for you.
[ENTER DATE & TIME]
[ENTER LOCATION]
Learn more at knowyourbackstory.com & let our office know if you would like to join [ENTER PHONE]!
Pain, heaviness, and tingling in the low back and legs may be signs of an enlarged ligament compressing spinal nerves.
Learn about treatment options like the Mild Procedure and hear real stories from real patients who have found lasting relief and began their next chapter at knowyourbackstory.com.
Let us help you rewrite your “back story.” Contact [PRACTICE] at [PHONE NUMBER] or [WEBSITE] today.
Your story shouldn’t end with low back and leg pain. If pain, heaviness, and tingling in your low back and legs is limiting the things you need to do…the things you love to do, it may be time to rewrite your story.
Learn about the signs and symptoms of an enlarged ligament and find out whether the Mild Procedure, a proven treatment option that can help relieve pain and restore mobility, may be right for you at KnowYourBackStory.com.
If you experience pain, heaviness, and tingling in your low back, they may be signs of an enlarged ligament compressing spinal nerves.
Contact [PRACTICE] at [PHONE NUMBER] or [WEBSITE] to review your history and imaging to get the full picture and start rewriting your back story.
Looking for more information? Hear from others who’ve found lasting relief and learn about your treatment options, like the Mild Procedure, at KnowYourBackStory.com.
Incorporate these GIFs into your texts and social media to make your communication fun and eye-catching.
Let's Get Moving!
Provide your patients and community information about LSS and encourage them to connect with your practice to have a conversation with about the steps that can be taken, like the mild® Procedure, to get moving!
Know Your Back Story is a national health awareness campaign that educates and encourages millions of people with chronic low back pain and their healthcare providers to learn more about their “back story,” including the potential cause, lumbar spinal stenosis (LSS), screening, the importance of looking for the enlarged ligament on imaging, and potential treatment options. The campaign will encourage people to use our physician finder to find a spine health doctor in their area, like your practice.
Ensure your website has information about LSS and mild® so your community can see what you have to offer to help with chronic low back pain.
Website Text
Copy and paste the following directly onto your site:
About the mild® Procedure
mild® is a short, outpatient treatment for lumbar spinal stenosis (LSS) that restores space in the spinal canal to help improve back and leg pain.* Using specialized tools and imaging, mild® addresses a major root cause of LSS by removing thickened ligament through an incision smaller than the size of baby aspirin, leaving no implants behind, only a Band-Aid.
The minimally invasive mild® Procedure has a safety profile similar to epidural steroid injections but with lasting results, and patients typically return to normal activity within 24 hours with no restrictions.* mild® is covered nationwide by Medicare (all ages, all plan types, including Medicare Advantage) the VA, U.S. Military & IHS. Commercial coverage varies.
If you are actively offering mild® to your community, make sure they can find you! Check our Find a mild® Doctor website resource to make sure all of your office locations are included.
Ensure your referring physicians know how your practice is able to help their patients with pain! Build connections and educate them so they know what you have to offer their chronic low back pain patients.
Referring Practices
Ensure physical therapists, primary care physicians, orthopedic surgeons, and other practices/specialties in your area who treat patients with chronic low back pain know:
How to identify the most common symptoms of LSS; look for the “Shopping Cart Syndrome”
Your interventional pain practice offers minimally invasive options
Educational Tools
Utilize resources from Vertosmed.com, including the Animation Video, Patient Education Video, clinical articles, and blogs to help educate peers about LSS and the mild® Procedure.
Provide patient education materials such as the Patient Brochure and ESI Postcard. Remember to attach your practice information or affix a label.
Move More Questionnaire
Keep referring practices informed of their patients’ progress after mild®. Make sure they are aware of the functional improvements and how consistent those results are with other patients in your practice.
We’re here to help! Team Vertos is committed to ensuring your practice has a strong foundation of tools to educate your community about the Know Your Back Story initiative and the mild® Procedure. Please reach out if you need further assistance in optimizing these resources.
For additional marketing-related questions, please email us at mild@vertosmed.com.
As an Advanced Practice Provider (APP), you are an integral part in helping patients with lumbar spinal stenosis (LSS) get on the path to lasting relief.
In this webinar workshop, led by our panel of mild® experts, APPs Ashley Comer, NP, Marie Zambelli, NP, Kelsey Kimball, PA, Lauren Cote, NP, Patrick McGinn, PA, Kristen Klein, NP, discuss how patient education and proper outcomes assessment play an important role in optimizing patient outcomes after the mild® Procedure.
According to our Advanced Practice Provider (APP) Advisory Board, imaging review, a key aspect of mild® patient candidate identification, is often not included in initial schooling. To help APPs learn the basics of image review, become more familiar with identifying anatomical landmarks, and understand how to confirm if a patient is a candidate for the mild® Procedure, we asked James Lynch—an APP with the Pain Consultants of San Diego—to walk us through his tips and techniques for magnetic resonance imaging (MRI) review. In the following article, he shares pearls for becoming confident in imaging review and provides a series of videos so you can follow his step-by-step approach to determine if patients with lumbar spinal stenosis (LSS) should make the move to mild®.
As an APP in an Interventional Pain Medicine practice that offers the mild® Procedure, reviewing MRI images to determine the presence of hypertrophic ligamentum flavum (HLF) is a critical aspect of my role. Prior to joining this practice, I had very little experience reviewing MRI images. It was not part of the core curriculum while training to become an APP, and it was not an area that I felt very confident in. I’ve become more familiar and proficient with imaging review; however, I can say that it’s much more straightforward than it may initially seem. Through hands-on experience, by sharing clinical pearls among peers, and by watching step-by-step videos like those included in this article, I became competent, comfortable, and confident performing image reviews to identify mild® patient candidates—and I know other APPs can too.
Why Is Imaging Review Important?
We know that up to 85% of spinal canal narrowing is caused by thickened ligament. When we see patients with symptomatic LSS, if HLF is present, we will likely advance to mild® to provide patients long-term relief using a therapy that has a safety profile equivalent to an epidural steroid injection (ESI), but with lasting results. Being able to review a basic MRI empowers me to identify patients who may benefit from the mild® Procedure and confidently present my recommendations to them. This confidence helps build trust between me and my patients, and makes them feel more comfortable and assured prior to scheduling their mild® Procedure. Having more patients move to mild® means that I’m giving my patients a chance to achieve clinically meaningful, statistically significant improvements in mobility, Oswestry Disability Index (ODI), and pain reduction on the Numeric Pain Rating Scale (NPRS). It’s also incredibly rewarding to hear patients tell me about what they’re able to do now that they can walk further and do more activities than they could before.
MRI Imaging Review with mild® in Mind: A Step-by-Step Approach
LSS is highly recognizable by the signs and symptoms patients commonly exhibit, including pain, numbness, or heaviness when standing or walking, and finding relief by sitting, bending forward, or sleeping curled in the fetal position. When we see these signs in our patients, we’ll order an MRI to confirm the diagnosis and determine whether the patient is a good candidate for the mild® Procedure.
When we request an MRI, we’ll get a report and the imaging back for that patient. During my review of the report, I look line-by-line, specifically confirming whether the report notes central canal stenosis. It is also helpful to make note of other contributors to central canal stenosis (such as enlarged facets, disc bulge, etc.) in order to properly prepare a patient for potential follow-up expectations.
Tip: As you gain comfort with image review, practice reviewing the MRI first and report second to confirm their diagnoses.
In the example shown here, I would note the following:
At L2 or L3, the patient has mild-to-moderate bilateral facet and ligamentum hypertrophy; however, the central canal remains patent and the patient does not have central canal stenosis at this level.
At L3-L4, the patient has moderate to severe central canal stenosis with a residual canal diameter of 6 mm.
Reminder: You can also request that the radiology report include a measurement of the HLF, which can make it easier to review.
Because I have confirmed the presence of central canal stenosis in the report, I’ll then review the imaging to determine whether the patient is a candidate for the mild® Procedure. You can also take the reverse approach and review the imaging first, and then use the radiology report as a confirmation of your own findings.
Step 1: Linking the Sagittal and Axial Views
A note on software: While the specific software demonstrated in this blog is Ambra Health, much of the imaging software used today is similar in function and review procedures. Whether you’re using Ambra Health, Sharp, or another software option, the tips and tricks demonstrated in this blog should be consistent, regardless of the software you’re using.
In pulling up the images, I typically begin setting up the images to facilitate a clear and efficient review process. Begin by adjusting the layout of the software to show 2 images at the same time.
On the left-hand side, we will show the sagittal view, or vertical cross-section of the patient. On the right-hand side, the axial view, or horizontal cross-section of the patient, will be displayed.
Press the “Link” command in the system software to correlate the images together and select the STIR images (T2 weighted images).
Tip: The reason I use the T2 image is because the cerebral spinal fluid actually brightens up, making it a lot easier to assess the spinal canal.
Step 2: Identifying Anatomical Landmarks
Vertebral Body
Central Canal
Epidural Fat
Ligamentum Flavum
Spinous Process
Exiting Nerve Root Space Under Pedicle Facet Joint
Facet
My specific area of interest in evaluating the mild® patient candidate is the small black area, which is the ligamentum flavum, highlighted in the image here.
In the small white area, we can see the central canal where the nerves are housed. In this image, we can see that the canal is very small, with very little white showing. This is consistent with central canal stenosis, and in this case, we can see clearly that the hypertrophic ligamentum flavum is compressing the nerves.
By moving our image up to L2-L3, we can see an excellent comparison of the healthy central canal. The large white area shows that at this level, the thin black ligament is not compressing the nerves.
In the sagittal view, you’ll be able to see clearly where the spinal canal narrows, and this is helpful in identifying all levels where the central canal is stenosed.
We can also see here that the patient has a disc bulge, indicative of multi-factorial central canal stenosis.
It’s important to remember that comorbidities are common among LSS patients—in fact, a Level-1 clinical study of mild® patients demonstrated that just 5% of patients presented with central canal stenosis only.The presence of comorbidities, such as foraminal narrowing, lateral recess narrowing, or facet hypertrophy DO NOT RULE OUT patients as mild® Procedure candidates. Indeed, the same clinical study found that the majority of patients with comorbidities achieved an ODI improvement of ≥10 points at 2-year follow-up.
Step 3: Measuring the Ligamentum Flavum
Using the length tool in the software, I can draw a line across the ligament (the dark area indicated in the image below) to obtain the ligament measurement.
Here, the measurement clearly shows an HLF of 6.38 mm. I will then repeat this measurement process at each of the levels that are affected by central stenosis (per the report, and as seen in the sagittal view).
Tip: As a reminder, any patients with HLF ≥2.5 mm may be considered a candidate for the mild® Procedure.
My Pearls for Easier Imaging Review
Once you become familiar with imaging review, you’ll develop your own tips and tricks that make the process easier and more efficient for you. Here are a few things that I suggest that can help when you’re just getting started:
Request an HLF measurement in the report.If I see a patient that is suffering from “Shopping Cart Syndrome” and exhibiting symptoms consistent with lumbar stenosis with neurogenic claudication, I’ll put the primary diagnosis code as “lumbar stenosis with neurogenic claudication” on the MRI request. I’ll also add a note to the order for the radiologist to measure the ligamentum flavum at the levels that are being affected and are stenotic. This can also be programmed into your EMR system as an automated note for every lumbar MRI request.
Scroll to find the best view. When the MRI is capturing images, it’s going to be at different depths, and may vary depending on the position of the patient. After I select the level of interest, I’ll typically scroll through several images (using the up and down arrow keys on my keyboard) to make sure I have the clearest view of the ligament and central canal.
Find your level by starting at the sacrum. It’s possible to determine which level you’re looking at by counting from the sacrum. I also keep in mind that L5-S1 is where the spine really starts to have curvature.
Focus on restoring functionality. If HLF is present in the MRI, we can feel confident about a decision to move to mild®, to provide LSS patients long-term relief using a therapy that has a safety profile equivalent to an ESI, but with lasting results.It’s common that you’ll see comorbidities that will need to be addressed eventually, but we’ll often begin with the mild® Procedure to restore functionality and help patients get back on their feet.
An Ideal mild® Procedure Candidate
In this video, you can see an end-to-end example of the imaging review for an ideal mild® case. In under 5 minutes, you can see how I:
Review the report: Start going line-by-line. At L4-L5, the patient appears to have bulking of the ligamentum flavum, resulting in narrowing of the central canal with no other noted comorbidities.
Link sagittal and axial images: After selecting a 2-image layout, select the T2 images, where cerebral spinal fluid brightens up, making it easier to identify the spinal canal.
Evaluate the level of central canal stenosis: Even though the radiologist has provided a report, I like to review the nuances of the images, knowing that I’m looking specifically to determine whether the patient is a good candidate for mild®.
Measure the ligamentum flavum: With my length tool, I can measure the ligament to make sure the HLF is ≥2.5 mm. In this case, an HLF of 4.18 mm confirms the patient is a candidate for mild®.
What if MRI isn’t an Option?
When a patient can’t have an MRI, we will instead send them in for a computed tomography (CT), ideally with a myelogram. A myelogram will highlight these relevant anatomical structures, so you can see the ligament and determine the patient’s candidacy. Even if a myelogram is not an option, be sure to indicate a primary diagnosis for lumbar stenosis when you order the CT, and the radiologist will then assess that patient for lumbar stenosis and HLF.
Using Imaging to Support Patient Education
When patients are in the office, I’ll often bring my laptop into the exam room and show them their imaging on screen. Being able to see their own anatomy, and specifically the hypertrophic ligament pressing on the nerves, is incredibly helpful to demonstrate this root cause of their LSS.
Then, I can also use the imaging to clearly point out how mild® addresses a major root cause of LSS by removing excess ligament tissue and leaving no implants behind. I’ll also show them where the nerves are being compressed and educate them about how mild® restores space in the spinal canal, which reduces the compression of the nerves. Most patients understand how the mild® Procedure works much more easily when they can see the images themselves, and it also helps them realize how the mild® Procedure can provide long-term relief and restore mobility.
Embracing Imaging Review: Don’t Be Intimidated—Practice Makes Perfect!
When I first started with imaging review, I was much less comfortable and confident than I am today. Knowing that our practice is committed to helping more patients move to mild®, I recognized that becoming comfortable with imaging review was a critical aspect of my role. Even though MRI review was not something included in my initial APP education, I realized that becoming proficient gave me an opportunity to bring additional value to our patients and practice.
The best way I found to get comfortable with imaging review was to dive in and review previous cases so I could become familiar with the anatomy and structures. Beyond hands-on experience, there are resources that offer additional support, including:
Online video resources:There are many videos available online that walk you through MRI reviews and will help you become more familiar with some of the structures.
Clinicians in your practice:Work with other physicians and APPs in your practice to hone your skills. I’d often review an MRI, and then share my findings with the physician I work with to confirm that they were seeing the same diagnosis that I saw.
Webinars:View webinars geared towards APP education, especially in imaging, such as The APP Imaging Workshop—A Collaborative Approach to mild® Patient Selection here.
Your Vertos representative: Our Vertos representative has been a great resource for our practice and is especially supportive when it comes to imaging. Connect with your representative to schedule a lunch-and-learn or meeting to review images together and access the latest educational materials.
With additional practice and experience, you’ll quickly become much more comfortable with imaging review. You’ll also notice how many of your patients with LSS have HLF and are candidates for the mild® Procedure. By putting more patients on the path to lasting relief with mild®, you’ll get to see first-hand how regaining mobility can be a life-changing improvement for the patients in your care.
What is Lumbar Spinal Stenosis?
Lumbar spinal stenosis, or LSS, is a common condition in which the lower spinal canal narrows and compresses the nerves in the lower back. Lumbar spinal stenosis is generally caused by aging and natural wear and tear on the spine. With lumbar spinal stenosis, thickened ligament, overgrowth of bone, and/or bulging discs in the lower back put pressure on the spinal nerves. This pressure can cause a variety of symptoms that affect daily life, including pain and limited mobility.
Up to 85% of spinal canal narrowing is caused by thickened ligament.
Lumbar spinal stenosis (LSS) is a common condition. In fact, over two million LSS patients nationwide are diagnosed and treated annually.LSS is generally found in people over the age of 50, and the likelihood of developing LSS increases with age.
Lumbar spinal stenosis is diagnosed by a medical history that includes a review of symptoms, as well as other tests that may be performed to verify LSS, including physical examinations to test mobility, and imaging such as X-rays, MRI, and CT scans.
People diagnosed with lumbar spinal stenosis may also have been diagnosed with, or be affected by, several other conditions of the lower back, including spondylosis, degenerative disc disease, foraminal narrowing, lateral recess narrowing, or facet hypertrophy.
Treatment options for lumbar spinal stenosis include conservative therapies (e.g., physical therapy, pain medication, chiropractic), epidural steroid injections, the mild® Procedure, spacer implants, and open surgery. mild® is an early treatment option to consider when conservative therapies are not providing adequate relief.
mild® is the only treatment with a safety profile similar to an injection, and the lasting relief expected from back surgery.
The mild® Procedure addresses a major root cause of LSS by removing excess ligament tissue to restore space in the spinal canal.
What is Neurogenic Claudication?
Neurogenic claudication (NC) is a syndrome, also described as a “collection of symptoms,” that is commonly diagnosed with lumbar spinal stenosis. Symptoms associated with NC result from the narrowing of the spinal canal that compresses the nerves in the lower back, and include pain, numbness, tingling, or heaviness in the lower back and legs. These symptoms are often brought on by walking or standing, as an upright posture places additional pressure on the nerves in the lower back. Symptoms may be relieved by sitting, bending forward, or sleeping curled in the fetal position, which can help reduce pressure on the spinal nerves.
Lumbar spinal stenosis with neurogenic claudication can be treated by a range of therapies that include conservative approaches such as medication or physical therapy, minimally invasive treatments, or surgery. The mild® Procedure is a minimally invasive option that addresses a major root cause of LSS by removing excess ligament tissue to restore space in the spinal canal. By reducing the compression on the nerves, the mild® Procedure helps restore mobility and relieve lower back and leg pain associated with neurogenic claudication.
What are the Symptoms of Lumbar Spinal Stenosis (LSS) with Neurogenic Claudication (NC)?
Symptoms of LSS with NC include pain, numbness, tingling, or heaviness while standing or walking that is relieved by sitting, bending forward, or sleeping curled in the fetal position.
“It affects everything you do in life. I was probably able to walk [only] 10 to 15 minutes. I told my family that unless something changed, we wouldn’t be having a big Christmas meal next year. But things changed, and we had the big dinner.”
How is Lumbar Spinal Stenosis with Neurogenic Claudication Diagnosed?
Lumbar spinal stenosis with neurogenic claudication is diagnosed by a doctor or Advanced Practice Provider (APP). In addition to taking a medical history that includes a list of symptoms, other tests that may be performed to verify LSS with NC include:
Physical examinations to test mobility
X-rays
MRI
CT scan
During the patient consultation, healthcare providers may ask patients a series of questions to understand how LSS affects the patient, including:
How long can you stand before you need to rest?
How far can you walk before you need to rest?
Do you often lean on shopping carts and other objects for support?
How does pain disrupt your life?
Using these questions, providers can determine if the patient is a good candidate for mild®, a treatment that addresses a major root cause of their LSS with neurogenic claudication.
If you would like to locate a doctor who treats lumbar spinal stenosis with neurogenic claudication in your area, click here.
“When patients have neurogenic claudication, their spinal canal has narrowed. If you think about your spinal canal, it’s like a garden hose. It is a nice, round circle which allows neural input from the brain to get to the lower extremities. If the garden hose gets a kink in it, less water comes out of the hose to water your plants, or in this case, less neural information from the brain gets to the lower extremities. By debulking the excess ligament that causes the kink, we can create more space and provide relief.”
– Dr. Denis Patterson, Nevada Advanced Pain Specialists
What are Common Treatments for LSS with NC?
The following chart compares several options that are typically recommended for LSS patients when conservative therapies (e.g., physical therapy, pain medication, chiropractic) are not providing adequate relief. Every therapy has risks and benefits. Only you and your doctor can decide which option is best for you.
What is the Difference Between an Epidural Steroid Injection and the mild® Procedure?
Two common treatments for lumbar spinal stenosis with NC are epidural steroid injections and the mild® Procedure.
An epidural steroid injection, which is a medication injected in the lower spine to reduce swelling and offer pain relief, is typically offered to LSS patients when non-medical care methods like exercise and physical therapy have failed to provide relief. The steroid medication in the injection is believed to reduce inflammation which relieves pain; however, injections only treat the symptoms of LSS and do not address the root cause of the problem.
The effects of epidural steroid injections typically last less than 6 months
To provide long-term relief, patients often require 2-3 injections in the lower back on average per year
Steroid use is known to increase risk of infections and may cause bone loss known as osteoporosis
The mild® Procedure – Minimally Invasive Lumbar Decompression
The mild® Procedure is a short, outpatient procedure that can be performed using only local anesthetic and light sedation. The procedure is performed through an incision in the lower back which is smaller than the size of a baby aspirin, or the diameter of a drinking straw (5.1mm) (Figure 1). The mild® Procedure addresses a major root cause of LSS by removing excess ligament tissue which has built up around the spine. This restores space around the spinal cord, which reduces the pressure on the nerves in the lower back (Figure 3).
The mild® Procedure does not leave behind an implant, and patients typically resume normal activity in 24 hours with no restrictions.
The mild® Procedure does not require stitches, staples, or complex bandaging. Typically, patients leave the outpatient procedure facility, with just a Band-Aid covering their incision, and visit their doctor a few days post-procedure for a quick wound check to ensure healing is progressing normally.
mild® has a safety profile similar to epidural steroid injections, but with lasting results.
mild® doesn’t eliminate future treatment options because no major structural anatomy of the spine is altered.
Research identifies mild® as a first-line treatment option for LSS, with several key advantages, including lasting pain relief and increased mobility.The mild® Procedure is the only treatment with a safety profile similar to an injection, and the lasting relief expected from back surgery.A Cleveland Clinic 5-Year Study showed mild® helped 88% of patients avoid back surgery for at least 5 years while providing lasting relief.
How does mild® Procedure Treat LSS with NC?
Up to 85% of spinal canal narrowing is caused by thickened ligament. mild® addresses this major root cause of LSS, by removing excess ligament tissue using specialized tools and imaging, and leaves no implants behind.
What Should Patients with LSS with NC Expect from Their mild® Procedure?
The mild® Procedure is a short, outpatient procedure with a safety profile similar to an injection.The procedure can be performed using only local anesthetic and light sedation and leaves no implants or stitches behind, only a Band-Aid. Most patients return to their normal activity level in 24 hours with no restrictions and see functional improvement over time. To optimize the results of the mild® Procedure, patients are encouraged to participate in a reconditioning program to regain strength and mobility.
Patients typically recover and resume normal activity within 24 hours with no restrictions.
Is the mild® Procedure an Effective Treatment for LSS with NC?
The mild® Procedure has been proven an effective treatment for LSS with NC. In a Cleveland Clinic study, mild® helped 88% of patients avoid back surgery for at least 5 years while providing lasting relief.
Every year, thousands of LSS patients are able to stand longer and walk farther with less pain, thanks to mild®.
In a separate study conducted by the Cleveland Clinic, clinicians tracked patient results for one year after the mild® Procedure. The published data showed:
Average standing time increased from 8 to 56 minutes with less pain
Average walking distance increased from 246 to 3,956 feet with less pain
“Before, I couldn’t walk a block without having to sit down and bend over. When I was going through the epidurals, I’d have a few days of respite and then it would kick up again. Sometimes, I didn’t have any days–it just didn’t stop hurting. My doctor told me there was a procedure called the mild® Procedure and I said, ‘let’s do it.’ Since then, I’ve been a new person. I’m not in pain; I don’t need to bend over. Every day I pinch myself and say, ‘wow.’ I’m still walking without pain.”
If You Think You May Have Lumbar Spinal Stenosis with Neurogenic Claudication, What Steps Should You Take?
If you suspect you may have lumbar spinal stenosis with neurogenic claudication, the first step is to talk to a qualified doctor who specializes in treating LSS. If you have already received a diagnosis, mild® specialists in your area can help you confirm your diagnosis and get on the path to lasting relief.
Use our Find a mild® Doctor tool to connect with an interventional pain management specialist in your local area.
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.
Vertos is an equal employment opportunity workplace committed to pursuing and hiring a diverse workforce. We strive to grow our team with highly skilled people who share our culture and values. All qualified applicants will receive consideration for employment without regard to sex, age, color, race, religion, marital status, national origin, ancestry, sexual orientation, gender identity, physical & mental disability, medical condition, genetic information, veteran status, or any other basis protected by federal, state or local law.
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.
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Are pain and limited mobility part of your “back story”?
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Don’t write off chronic low back and leg pain.
Pain, heaviness, and tingling in the low back and legs may be signs of an enlarged ligament compressing spinal nerves.
Learn about treatment options like the Mild Procedure and hear real stories from real patients who have found lasting relief and began their next chapter at knowyourbackstory.com.
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Learn about the signs and symptoms of an enlarged ligament and find out whether the Mild Procedure, a proven treatment option that can help relieve pain and restore mobility, may be right for you at KnowYourBackStory.com.
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Contact [PRACTICE] at [PHONE NUMBER] or [WEBSITE] to review your history and imaging to get the full picture and start rewriting your back story.
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