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.

Optimizing Patient Outcomes

Tips from Advanced Practice Providers to communicate appropriate patient expectations after the mild® Procedure.

Creating Your mild® Talk Track

3 simple steps APPs can take today to enhance patient education (with video demonstration and helpful resources)

APP Imaging Workshop

Learn how practices are advancing their collaborative approach to mild® patient selection and care.

Identifying & Educating mild® Patients

Follow 3 easy steps to optimize your practice routine regarding symptoms, candidacy, and expectations.

Understanding Lumbar Spinal Stenosis with Neurogenic Claudication

What are the symptoms of Lumbar Spinal Stenosis (LSS) with Neurogenic Claudication (NC)?

Imaging Review Tips for Advance Practice Providers

MRI imaging review with mild® in mind: a step-by-step approach, and why image review is important.

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.

According to Mobility Matters: Landmark survey on chronic low back pain in America, an infographic. More than 72 million US adults report experiencing CLBP. 27 millions have never been told exactly what's causing their CLBP. More than 8 in 10 wish there were better treatment options for CLBP. Silhouette image of a woman with shopping cart syndrome leaning on a shopping cart to alleviate back pain symptoms. Silhouette image of a man sitting down on a chair to alleviate his back pain.

See more insights from the survey here >

Introducing the Mobility Index

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 Does Your 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.

Infographic - Mobility Index through the decades. Comparing pain and mobility differences between people with and without chronic low back pain (CLBP) in their 50s. Stand for 30+ minutes: 76% without CLBP, 33% with CLBP. Walk 1+mile: 75% without CLBP, 36% with CLBP. Dance through entire song: 77% without CLBP, 41% with CLBP. Often make it through day without any physical pain: 70% without CLBP, 30% with CLBP. Infographic - Mobility Index through the decades. Comparing pain and mobility differences between people with and without chronic low back pain (CLBP) in their 60s. Stand for 30+ minutes: 77% without CLBP, 35% with CLBP. Jogging: 50% without CLBP, 13% with CLBP. Satisfied with how well my body gets around: 80% without CLBP, 45% with CLBP. Often make it through day without any physical pain: 73% without CLBP, 31% with CLBP.Infographic - Mobility Index through the decades. Comparing pain and mobility differences between people with and without chronic low back pain (CLBP) 65 and older. Going up and down stairs: 79% without CLBP, 44% with CLBP. Walk 1+ mile: 70% without CLBP, 35% with CLBP. Satisfied with how well my body gets around: 81% without CLBP, 42% with CLBP. Often make it through day without any physical pain: 76% without CLBP, 31% with CLBP.Infographic - Mobility Index through the decades. Comparing pain and mobility differences between people with and without chronic low back pain (CLBP) in their 70s. Stand for 30+ minutes: 73% without CLBP, 36% with CLBP. Go up and down stairs: 80% without CLBP, 46% with CLBP. Gt up and down from floor: 66% without CLBP, 28% with CLBP. Often make it through day without any physical pain: 77% without CLBP, 31% with CLBP.

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?

Image: A physician in a white doctor's coat smiles and reassures an elderly patient, a smiling woman wearing a sweater. Text: Standing for 30+ Minutes. Among adults who don't suffer from CLBP, nearly 3 in 4 individuals aged 50-79 are able to easily stand for 30 minutes or longer. In contrast, the number of CLBP patients in the same age range who can do the same is just over 3 in 10.

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.

Image: Silhouettes of people walking lengthening distances on a chart. CLBP patients in their 50s that can easily walk for one mile or more, only 36%. Can easily dance through an entire song, only 41%. 50-somethings without CLBP that report being able to do these activities with ease, over 75%.

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%.

2 circle graphs. One shows 50% complete, the other only shows 13% complete.

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.

2 circle graphs. One shows 80% complete, the other only shows 45% complete.

Image: Elderly woman holding coffee mug, with glasses on her head, looking in the distance. Text: 7 in 10 patients between 50 and 79 say they are often unable to make it through the day without pain. Graph description: 10 body silhouettes, 7 out of 10 are colored in blue. 3 remain grey. 2nd graph description: 10 body silhouettes, 3 out of 10 are colored in navy blue. 7 remain grey. Text: Among their peers, this number drops to 3 in 10.

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.

Image: Elderly Hispanic couple walking down a staircase, hands on the banister, both smiling. Text: I can go up and down the stairs with ease. Graph: 80% shows non-CLBP, 45% shows CLBP.

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.

Image: White man in his 60s, sitting on the floor, receiving a helping hand, smiling and getting pulled up. Text: I can get up or down from the floor with ease. Non-CLBP 66%. CLBP 28%.

Could An Enlarged Ligament Be Causing Your Low Back Pain?

Image: White man in his 60s, sitting, hunched over in pain, with his hand on his lower back. Text: 84% of people suffering from CLBP report moderate or severe 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.

Image: White woman in her 60s, sitting, hunched over in pain, with her hand on her lower back. Text: 78% of adults with chronic low back pain don't know that an enlarged ligament could be the cause.

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.

US adults say CLBP has interfered with their ability to complete every day tasks: Exercising 63%, Standing 63%, Walking 58%, Getting a good night's sleep 55%

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.

89% of patients have been experiencing CLBP for1 year or more, with more than half (57%) experiencing it for more than 5 years. Circle graphs: 89% 1 year or more vs 57% more than 5 years.

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.

Find a spine health doctor in your area

Learn more about Mild

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.

According to Mobility Matters: Landmark survey on chronic low back pain in America, an infographic. More than 72 million US adults report experiencing CLBP. 27 millions have never been told exactly what's causing their CLBP. More than 8 in 10 wish there were better treatment options for CLBP.

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.

See more insights from the survey here >

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.

84% of people suffering from CLBP report moderate or severe pain

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.

US adults say CLBP has interfered with their ability to complete every day tasks: Exercising 63%, Standing 63%, Walking 58%, Getting a good night's sleep 55%

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.

Infographic - Mobility Index through the decades. Comparing pain and mobility differences between people with and without chronic low back pain (CLBP) in their 50sInfographic - Mobility Index through the decades. Comparing pain and mobility differences between people with and without chronic low back pain (CLBP) in their 60sInfographic - Mobility Index through the decades. Comparing pain and mobility differences between people with and without chronic low back pain (CLBP) 65 and older.Infographic - Mobility Index through the decades. Comparing pain and mobility differences between people with and without chronic low back pain (CLBP) in their 70s

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.

Standing for 30+ Minutes. Among adults who don't suffer from CLBP, nearly 3 in 4 individuals aged 50-79 are able to easily stand for 30 minutes or longer. In contrast, the number of CLBP patients in the same age range who can do the same is just over 3 in 10.

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.

CLBP patients in their 50s that can easily walk for one mile or more, only 36%. Can easily dance through an entire song, only 41%. 50-somethings without CLBP that report being able to do these activities with ease, over 75%.

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%.

 

Chart: 50% vs 13%

Fewer than half of CLBP patients in their 60s say they feel satisfied with how their body gets around. In contrast, 80 percent of 60-somethings without CLBP are satisfied with their mobility. Non-CLBP 80%, CLBP 45%

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.

I can go up and down the stairs with ease. Non-CLBP 80%. CLBP 45%.

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.

I can get up or down from the floor with ease. Non-CLBP 66%. CLBP 28%.

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.

The difference mild makes: stand 7x longer, walk 16x farther. Patients increased average standing time from 8 minutes to 56 minutes with less pain over one year. Patients increased average walking distance from 246 feet to 3,956 feet with less pain over one year.

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.

89% of patients have been experiencing CLBP for1 year or more, with more than half (57%) experiencing it for more than 5 years. 89% 1 year or more vs 57% more than 5 years.

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.

Learn more about Mild.

Access more resources about the Know Your Back Story Campaign and the Mobility Matters Poll

Background information, logos, and supporting research

Branding Assets

KYBS Logo - Enlarged Ligament

Information and assets about Vertos Medical and the mild® Procedure

Leadership Bios

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.

Logos

Please reach out if you have questions or need further assistance in utilizing these resources.

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!

Social Media Templates

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!

Invite Your Patients to an Event

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]!

Are pain and limited mobility part of your “back story”?

Find out if an enlarged ligament is causing your low back and leg pain and learn about your treatment options at knowyourbackstory.com.

Let us help you rewrite your back story. Learn more at knowyourbackstory.com and contact [PRACTICE] at [PHONE NUMBER] or [WEBSITE] today.

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.

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.

It’s time to rewrite your “back story.”

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.

Visit www.mildprocedure.com for more info.

*Clinical data available: https://www.vertosmed.com/patients/

Patient Education Video

Embed the video on webpages and in social posts to help patients understand the procedure and its benefits, through visually engaging animations.

Click the “Share” button on YouTube to get the embed code.

Website Images

Include Before/After mild® illustrations to showcase how mild® reduces compression on the nerves.

Find a mild® Doctor Tool

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:

  1. How to identify the most common symptoms of LSS; look for the “Shopping Cart Syndrome”
  2. Your interventional pain practice offers minimally invasive options

Patient Education Materials

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.

Contact Us

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.

Access the webinar here:

Looking for more info on mild® patient identification criteria?
Check out our blog: Identifying & Educating mild® Patients – APP Guidance

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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.


Getting Started: Reviewing the MRI Report

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.

Light bulb illustration icon

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.

Light bulb illustration

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).

star illustration

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

Image showing Vertebral Body

  1. Vertebral Body
  2. Central Canal
  3. Epidural Fat
  4. Ligamentum Flavum
  5. Spinous Process
  6. Exiting Nerve Root Space Under Pedicle Facet Joint
  7. Facet

image showing ligamentum flavum in patient suffering from lumbar spinal stenosis

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.

image showing hypertrophic ligamentum flavum compressing the nerves

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.

image showing comparison of the healthy central canal

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.

sagittal view showing where the spinal canal narrows where the central canal is stenosed

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.

image showing an HLF measurement of 6.38 mm

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).

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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:

  1. 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.
  2. 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.
  3. 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.
  4. 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.

Illustration of an aging spine of a person suffering from lumbar spinal stenosis

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?

Illustration of back pain caused by neurogenic claudicationIllustration of people sitting and pushing a shopping cart with 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.

Chart showing descriptions of symptoms for people suffering from lumbar stenosis with neurogenic claudication


“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.”

Watch Lynn’s story

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.

Infographic showing benefits of mild procedure compared to other treatments for neurogenic claudication

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.

Photos showing before and after images of a patient treated with the mild® Procedure and suffering from lumbar spinal stenosis

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

Graphic showing how individuals improve standing time and walking distance after the mild® Procedure


“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.”

Watch Nicky’s Story

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.

Advanced Practice Providers (APPs) play a vital role in helping patients understand their lumbar spinal stenosis (LSS) diagnosis and treatment recommendations. By developing strong provider-patient communication, you’re taking the first step towards achieving positive outcomes and enhancing the patient experience.

Why is patient education so important?

  • Limited health literacy is linked to a spectrum of suboptimal health outcomes, including increased reports of poor physical functioning, pain, limitations in activities of daily living, and poor mental health status (Source)
  • Only about 12 percent of U.S. adults demonstrate proficient health literacy skills (Source)
  • Limited health literacy disproportionately affects adults aged 65 and older (Source)

Based on the data above, it is clear that patients over 65 years of age–the group most likely to suffer from LSS–may need more support to understand their condition and treatment plan. With the recognition that both lumbar spinal stenosis and poor health literacy can increase your patients’ susceptibility to poor physical functioning, pain, and limitations in activities of daily living, APPs should feel especially empowered to engage patients. This includes helpful education and dialogue that supports their understanding and helps them feel more comfortable taking the next step on their path to lasting relief.

In the following article, you will find step-by-step guidance and pragmatic suggestions that you can start using today, to help you ensure that your patients leave their consultation feeling confident and excited about their opportunity to make the move to mild®.

Watch: See APP Ashley Comer’s complete talk track for presenting mild® to her LSS patients.

Teach Patients About mild® in 3 Easy Steps

Use the mild® patient brochure as a tool and follow these simple steps to help your patients better understand their lumbar spinal stenosis diagnosis and the benefits of the mild® Procedure.

Do you experience back and leg pain when you stand or walk? Have steroid injections stopped working? Get back on your feet with the mild® procedure

STEP 1: Explain LSS in Plain Language

LSS is a complex condition that can be challenging for patients to understand. It is important that patients comprehend the cause of their LSS symptoms, so they feel informed and confident in moving forward with a treatment plan.

icon of ringing bell

Skip the Medical Jargon

Instead of using complex medical terms or acronyms, simplify your explanation with common words, phrases, and analogies to help patients understand their diagnosis and treatment options.

According to the CDC, nearly 9 out of 10 adults struggle to understand and use personal health information when it’s filled with unfamiliar or complex terms. (Source)

On the first page of the mild® patient brochure, you’ll find helpful illustrations that demonstrate the anatomical changes associated with LSS and the symptoms patients typically experience. During your patient consultation, be sure to highlight:

Infographic showing the symptoms of lumbar spinal stenosis (LSS)

  • Compression of the nerves in the lower back.
    • LSS can develop as a result of aging and natural wear and tear on the spine
    • Thickened ligament is a major root cause of lumbar spinal stenosis
    • Symptoms are caused by pressure on spinal nerves
  • LSS symptoms affect daily life, causing pain and limited mobility. ASK YOUR PATIENT:
    • Do you feel pain, numbness, tingling, or heaviness when standing or walking?
    • Are your symptoms relieved by sitting, bending forward, or sleeping in the fetal position?

icon of a speech bubble

Relate LSS to Common, Lived Experiences

Many APPs and physicians use common, real-life analogies to help patients identify and understand their LSS symptoms. A common analogy that many patients may relate to is the “shopping cart syndrome.” Explaining that patients with lumbar spinal stenosis often feel relief when bending over a shopping cart (because it reduces pressure on the compressed nerves) can help patients recognize how this condition impacts their daily life.

STEP 2: Make the Discussion Specific to Your Patient

Once you’ve established the common signs and symptoms of LSS, demonstrate what the MRI shows for that specific patient. Turn to the last page of the mild® patient brochure, where you can use the diagrams provided. Drawing directly on the patient brochure, indicate the following:

What does your imaging show?

  • In the sagittal view on the left, note which level(s) are affected
  • In the axial view on the right, show how their thickened ligament appears in the MRI, being sure to draw over the nerves to demonstrate the impact on the central canal

Watch: See how APP Ashley Comer uses the illustrations in the mild® patient brochure to demonstrate her patients’ specific areas of stenosis.

You can also accompany the spinal illustrations in the mild® patient brochure with an added tool, such as a spine model or the patient’s MRI to reinforce the anatomical positioning of the problem or validate the diagnosis, respectively.

STEP 3: Highlight how the mild® Procedure Works

Once patients fully understand their condition, walk them through all of the reasons why you recommend they make the move to mild®. If you turn back to the beginning of the brochure (or access the same information in the mild® patient flip chart) and review the remaining pages, you can quickly cover the advantages of mild® relative to other treatment options, and prepare your patients for what to expect during and after their mild® Procedure.

Page 2: Comparing Treatment Options

Infographic showing the benefits of the mild® procedure compared to other treatments for lumbar spinal stenosis

  • The chart in the center of the page quickly presents mild® benefits in comparison to other treatment options for LSS, such as epidural steroid injections, spacer implants, or open surgery
  • Below the chart, the call out reinforces the unique advantages of mild® as the only treatment with a safety profile similar to an injection, and the lasting relief expected from back surgery

MOVE2mild®

Because epidural steroid injections (ESIs) were historically the standard of care for lumbar spinal stenosis patients, your patient may be expecting you to recommend another injection. You can explain that the data shows that there is no benefit to giving more than one ESI before mild®, and that giving more than one ESI delays the patient from receiving the longer-lasting, more effective mild® Procedure.

Page 3: How mild® Removes the Problem and Leaves Nothing Behind

Infographic showing an illustrations of spinal compression before and after the mild® procedure

  • mild® addresses a major root cause of LSS by removing excess ligament tissue
  • mild® reduces compression on the nerves to restore mobility and relieve pain
  • mild® doesn’t eliminate future treatment options, as no major structural anatomy of the spine is altered

Page 4: What to Expect on the Day of the mild® Procedure

Infographic explaining what a patient can expect the day they will receive the mild® procedure

  • Short outpatient procedure
  • Can be performed using local anesthetic and light sedation
  • Incision smaller than the size of a baby aspirin
  • Patients typically resume normal activity within 24 hours with no restrictions

Page 5: What to Expect After the mild® Procedure

Infographic showing proven results of the mild® procedure in treating lumbar spinal stenosis

  • mild® has an 85% patient satisfaction rate
  • mild® continues to improve patient functionality over time
    • Over one year, average standing time increased 7x from 8 to 56 minutes with less pain
    • Over one year, average walking distance increased 16x from 246 to 3,956 feet with less pain
  • mild® helped 88% of patients avoid back surgery for at least 5 years, while providing lasting relief
  • mild® is covered by Medicare (including Medicare Advantage), the VA, U.S. Military, & IHS. Commercial coverage varies.

Setting Expectations Supports Patient Success

icon of a bell ringing

Every year, thousands of lumbar spinal stenosis patients are able to stand longer and walk farther with less pain thanks to the mild® Procedure, but those results aren’t achieved overnight. Improvements in patient functionality are typically achieved over time, with patients gradually increasing standing time and walking distance. If you set expectations in advance, patients may be more excited and satisfied to see their own functional improvements over time.

BONUS: Tips to Make Patient Education More Impactful
  1. Project confidence. When you showcase your knowledge and present information in ways patients can easily understand, they may feel more comfortable making decisions and following your recommendations.
  2. Encourage patients to ask questions. Take a moment between steps to confirm your patient understands the key points before moving to the next point.
  3. Discuss the benefits of reconditioning. When setting expectations around recovery, discuss the ways that patients can participate in improving their functionality. Help your patients get back on their feet by suggesting progressively longer walks, or even physical therapy.

Better Patient Education Helps Drive Success with mild®

LSS patients rely on APPs as critical members of their care team. Across the patient journey from diagnosing your patients’ LSS to finding relief with the mild® Procedure, APPs are key in supporting patients, helping them understand their condition, and feeling confident about their decision to make the move to mild®.

At Vertos, we recognize and support the role of APPs and are committed to providing education and resources that help you put more LSS patients on the path to lasting relief.

Don’t miss out on the latest and greatest tips and tools from Vertos.

  1. Register as an APP to stay informed of new peer-to-peer learning and other educational opportunities
  2. Follow us on social
  3. Connect with your Vertos rep for educational resources

Interventional Pain Management is a fast-growing specialty. As new lumbar spinal stenosis (LSS) procedures become available, practices are evolving the way they collaborate and work together to optimize patient care. The mild® Procedure’s patient selection process is quite simple, but requires imaging review, which is often not a part of Advanced Practice Providers’ (APP) traditional education.

The Vertos APP Advisory Board has emphasized the need for educational tools for APPs who would like to develop their image review skillset. Two of the esteemed Vertos APP Board Members, James Lynch, PA and Kelsey Kimball, PA, partnered with their physicians Dr. Michael Verdolin and Dr. Ajay Antony to provide an interactive workshop focused on enhancing imaging review skillsets. View the interactive workshop where they cover imaging basics, navigating software, measuring the ligament, and more!

  • LSS & mild® Patient Identification Overview (2:20)
  • MRI Basics (9:59)
  • Anatomical Review (15:58)
  • Navigating Imaging Software (27:24)
  • mild® Case Studies (1:02:26)
  • Benefits of Incorporating Image Review Into Your Practice (1:09:12)
  • Additional Educational Resources Available (1:12:43)
  • Q&A (1:15:13)

Looking for more info on mild® patient identification criteria? Check out our blog: Identifying & Educating mild® Patients – APP Guidance.

Also, be sure to connect with us to stay informed of upcoming APP-specific educational and peer engagement opportunities. Sign up and receive the latest updates!

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There’s good news for patients suffering from chronic lower back pain caused by lumbar spinal stenosis (LSS), as effective treatment options have become more widely available. Traditionally, administering a series of epidural steroid injections (ESIs) had been considered the standard of care, but the short-term results­—typically lasting less than 6 months—left many doctors and patients looking for a more durable solution. Rather than enduring one injection after another, up to 2-3 injections per year, the minimally invasive mild® Procedure has become an increasingly sought after alternative for patients with LSS.

A recent study published in Future Medicine, highlighted some of the top reasons doctors and patients are making the move to the mild® Procedure, or, minimally invasive lumbar decompression. The mild® Procedure is a treatment option that addresses a major root cause of LSS, requires only local anesthetic and light sedation, and leaves no implant behind.

Here’s an overview about ESIs, the mild® Procedure, and how to find an interventional pain provider capable of telling you more about the procedure and its potential benefits.

Epidural Steroid Injections

Epidural steroid injections—medication injected in the lower spine to reduce swelling and offer pain relief—are typically offered to lumbar spinal stenosis 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 stenosis and do not address the problem’s root cause.

The effects of an epidural steroid injection typically last less than 6 months so patients generally require 2-3 injections per year. Repeat steroid use is known to increase risk of infections and may cause bone loss (osteoporosis).

Faye - mild® Procedure for back pain patient

“Being in pain constantly is frustrating. I’m an active person and I wanted to get better. My orthopedic surgeon diagnosed me with spinal stenosis and ordered 3 injections of the cortisone over a period of about 4 weeks. The first shot took away the severe pain, but I was still hurting. And that remained the case after the second and third injections.

I waited about 2 months and then he gave me 2 options: open back surgery, with metal plates between the vertebrae, or get more shots. I wanted something simple that would make me better, and that’s when I found the mild® Procedure.”
-Faye, mild® Patient

Minimally Invasive Lumbar Decompression: The mild® Procedure

If epidural steroid injections aren’t effective for you, it’s important to know that your interventional pain provider may offer other treatment options. Proactively discussing and considering different options can help you and your doctor make the right treatment decision at the appropriate time.

The recent study highlighted several advantages of the mild® Procedure, including:

  • The mild® Procedure addresses a major root cause of lumbar spinal stenosis by removing excess ligament. This restores space in the area around the spinal cord, reducing pressure on the nerves in the lower back.
  • The mild® Procedure has been shown to provide superior clinical performance to epidural steroid injections and provides lasting relief, with 88% of patients avoiding open back surgery for at least 5 years
  • The mild® Procedure is a short outpatient procedure. It is typically performed using only local anesthetic and light sedation through a single incision that is smaller than the size of a baby aspirin (5.1mm).
  • The procedure does not require stitches, staples, or complex bandaging. Typically, patients leave the outpatient procedure facility with a just a Band-Aid covering their incision and visit their doctor a few weeks later.
  • The mild® Procedure does not leave behind an implant, and patients typically resume normal activity in 24 hours with no restrictions

Dante - mild® Procedure patient

“After mild®, I felt great, and the results have lasted. My golf game is nearly back, too. Anybody that meets the criteria of the procedure should do it. Why live in pain if you don’t have to?”
-Dante, mild® Patient

Find a mild® Doctor

Finding a doctor that offers the mild® Procedure is easy. The fastest way is to use the Find a mild® Doctor feature available on this website. The finder can help you locate a mild® provider in your preferred radius of your address, city, or ZIP code.

Find a Mild Procedure doctor in your area
Find a Mild Procedure doctor in your area
Find a mild® Doctor

Questions to Ask Your Doctor

When discussing treatment options with your doctor, be sure to ask specific questions, including:

  • How effective is the treatment I will receive?
  • How long will the treatment provide relief from my pain/discomfort?
  • What are the risks of the treatment? What are the benefits?
  • Where will the procedure be performed? How long does the procedure take?
  • How long is the recovery?

Hear Linda’s story on how mild® relieved her pain and enhanced her everyday life.

When to Start Your Search

The best time to start searching for a mild® Doctor is today. Chronic lower back pain caused by lumbar spinal stenosis typically worsens in severity over time, making early intervention crucial to restoring healthy function, movement, and quality of life. The study discussed here supports early use of the mild® Procedure, finding that:

  • There is no benefit to performing multiple epidural steroid injections before the mild® Procedure
  • Performing multiple epidural injections delays the patient from receiving a longer-lasting, more effective mild® treatment
  • Performing the mild® Procedure immediately upon diagnosis of lumbar spinal stenosis with thickened ligament, or after failure of the first epidural steroid injection, is recommended

Lynn - mild® Procedure testimonial

“Before the mild® Procedure, I had a hard time standing anytime at all, so that affected my baking and my cooking, sweeping the porch, pulling weeds: just everything I did, it affected it. I was probably able to walk for 10 to 15 minutes at a time. As a matter of fact, I told my family that unless something changed, we wouldn’t be having a big Christmas next year. After 2 epidural injections, I was already finished with them. Then, I had the mild® Procedure done, and it was a miracle. I do feel happier, I feel better. My friends and family can’t believe the difference. Christmas dinner is back on, because grandma’s back to cooking.”
-Lynn, mild® Patient

If you’re ready to learn more about the mild® Procedure, talk to your interventional pain provider or Find a mild® Doctor today.

mild® is often referred to as a “simple little procedure” that can make a major impact on the quality of life and mobility for lumbar spinal stenosis (LSS) patients. Minimally invasive lumbar decompression (mild®) removes the problem and leaves nothing behind—no implants, no stitches—allowing patients to stand longer and walk farther with less pain. A short, outpatient procedure, it is performed through a single 5.1mm incision in the patient’s lower back, addressing a major root cause of lumbar spinal stenosis by removing excess ligament tissue. Patients typically resume normal activity within 24 hours with no restrictions.

So, how do practices describe this “simple little procedure” to their patients? We like to say the mild® Procedure is similar to “removing a kink in a drinking straw,” reducing the compression on the nerves in the lower back to restore mobility and relieve pain.

Photos showing before and after images of a patient treated with the mild® Procedure and suffering from lumbar spinal stenosis

We asked a group of mild® physicians how they describe the mild® Procedure and its big, life-changing potential to their patients and referring physicians. We heard a lot of fun analogies—here are a few of our favorites.

ESI is like

Illustration of tape dispenser

mild® is like

illustration of glue bottle

Dr. Peter Pryzbylkowski; Linwood, NJ

I describe mild® to my patients as a “quality-of-life procedure.”

I walk them through my algorithm and I say, “Listen: I can put a temporary Band-Aid [solution] on this for you with an epidural steroid injection (ESI), or I have a tool in my toolkit that could hopefully fix this for you where it’s not just a Band-Aid. It really improves your quality of life.”

Once you frame it this way for patients—as an epidural being a Band-Aid, with mild® being more of a definitive procedure—you have a captive audience that typically wants to go ahead and get a percutaneous decompression.


For patients who know cardiology, ESI is like

illustration of a pill bottle

mild® is like

illustration of a stent

Dr. Brian Durkin; Port Jefferson, NY

Our patients are generally familiar with cardiology procedures. So, I tell them lumbar spinal stenosis treatment options are similar to the options available for patients with coronary artery stenosis. You can either treat them with meds to improve blood flow or put in a stent to open it up more permanently. The mild® Procedure restores space around the spinal cord, just like a stent restores space in your blood vessels.


ESI is like

illustration of a clogged drain

mild® is like

illustration of an unclogged drain

Dr. Brian J. Goentzel; Wichita, KS

I tell patients: “Your spinal canal is kind of like your sink when it gets clogged. If your sink is really clogged, you can pour Drano down it all you want. But that’s a temporary fix, and it doesn’t work long-term. At some point, you’ve got to get in and unclog the drain.”


ESI is like

illustration of a room cluttered with furniture

mild® is like

illustration of a room with an appropriate amount of furniture

Dr. Erin Chaney; Jacksonville, NC

I describe how mild® works like fixing a room that is overcrowded with furniture. I tell them:

“Imagine a room full of tables and chairs, and you just can’t move around. What I am going to do today is just take a couple of chairs out to make some more space, so your anatomical structures can move around easily.”


LSS is like

illustration of too many people in an elevator

mild® is like

illustration of a normal amount of people in an elevator

Dr. Dawood Sayed; Kansas City, KS

“When I describe what stenosis/LSS does to a patient’s spinal canal, I compare it to having too many people in an elevator. What we do with mild® is open the door and let a few people out so that the folks remaining have more room to move freely for the ride.”


How do you describe mild® to your patients? If you have an effective analogy you use to talk about the benefits of mild® or its approach, we’d love to hear about it. Email us today. If you need additional patient resources, please contact your Vertos representative.

As a mild® provider, it’s important to brand yourself as a mild® practice to attract new patients and educate people in your community who are searching for relief from lower back pain and mobility issues. By presenting the mild® Procedure as part of your treatment offerings, you can highlight that your practice provides advanced lumbar spinal stenosis (LSS) treatment options for potential patients searching for alternative solutions to epidural steroid injections (ESIs), pain medication, or back surgery.

The following patient education, healthcare professional, and digital (web/social) resources will help ensure your practice is well-equipped in identifying and educating the community and your referral networks about LSS, and how mild® can play an effective role in a patient’s care path.

Outfit your practice so patients know you offer the mild® Procedure.

Flip Chart

Use the 2-sided presentation tool to walk your patients through LSS, their treatment options, and what to expect with the mild® Procedure.

Patient Brochure

Send patients home with a reference tool to remind them of your consultation and reinforce your recommendations. Mark up the “What does your imaging show” page to identify stenosis level(s) and indicate contributing factors to spinal canal narrowing. Patient Brochure now available in Spanish.

Posters

Let patients know you offer an alternative to ESIs. Display posters in the lobby, exam rooms, and hallways so they can learn about mild® while they wait to see you. Two sizes available: small (18” x 24”) and large (24” x 36”).

ESI Patient Postcard

Distribute with routine discharge information so ESI patients know that if their symptoms don’t improve, their next step may be mild®.

Move More Questionnaire

Obtain a baseline assessment of each patient’s functionality to compare outcomes after mild®. Set expectations by reminding the patient that reconditioning and mobility improvement increases over time.

Patient Education Video

Stream the video on lobby screens and during consultations to help patients understand the procedure and its benefits, through visually engaging animations. The video includes but does not require audio.

Click the “Share” button on YouTube to get the embed code or contact us to request an MP4 format.

Your mild® Practice Blueprint

Learn more about how to outfit your practice, optimize resources, and guide patients through their treatment path. Contact your Vertos representative for a copy of the blueprint.

Add information about mild® to your website to help educate patients about the procedure.

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.

Visit www.mildprocedure.com for more info.

*Clinical data available: https://www.vertosmed.com/patients/

Patient Education Video

Embed the video on webpages and in social posts to help patients understand the procedure and its benefits, through visually engaging animations.

Click the “Share” button on YouTube to get the embed code.

Website Images

Include Before/After mild® illustrations to showcase how mild® reduces compression on the nerves.

Find a mild® Doctor Tool

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.

Connect with us: Stay up-to-date with the latest information on the mild® Procedure and tag us in your posts!

Social Media Templates

Incorporate these ready-to-use social media templates into your feed. Include hashtags: #mildprocedure #vertosmedical #lookfortheligament #MOVE2mild #lumbarspinalstenosis #lss.

Now Offering mild®

We are excited to announce that we offer the minimally invasive mild® Procedure for patients with lumbar spinal stenosis (LSS). This short, outpatient treatment removes a major root cause of lumbar spinal stenosis through an incision smaller than the size of a baby aspirin and has shown to significantly improve LSS pain and mobility.

Get in touch with [PRACTICE] to see if you may be a candidate for the mild® Procedure at [PHONE #] or [WEBSITE].

Symptoms of LSS

Pain, numbness, heaviness, and tingling in the lower back, legs, or buttocks when standing or walking are common symptoms of lumbar spinal stenosis (LSS) that can make doing everyday tasks unbearable. The minimally invasive mild® Procedure addresses a major root cause of stenosis, by restoring space in the spinal canal to help improve back and leg pain.

Find out if you may benefit from the mild® Procedure by contacting [PRACTICE] at [PHONE #] or [WEBSITE] today.

Patient Education Video

A common condition typically found in those over age 50, lumbar spinal stenosis (LSS) contributes to pain and mobility issues and may impact the ability to perform simple tasks. Watch this short patient education video to learn how the minimally invasive mild® Procedure may help those with LSS achieve lasting relief.

Find out if you may benefit from the mild® Procedure by contacting [PRACTICE] at [PHONE #] or [WEBSITE] today.

Click the “Share” button on YouTube to embed the video in your social post.

Additional content and tools designed specifically for APPs to help identify and educate patients.

mild® Quick Reference Card

Use the handy reference tool to ID mild® patients, including symptoms, indications, and benefits. Perfectly sized to fit in your lab coat pocket, on your badge reel, or clip to a workstation. Check out our blog Identifying & Educating mild® Patients – APP Guidance for patient identification tips and best practices.

Personalized, Virtual, or On-site Training

Vertos representatives are available to answer questions or deliver customized training sessions aligned to your team’s learning priorities. Reach out to your local representative to schedule a training.

Build connections with referring physicians to help attract more patients to your practice.

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:

  1. How to identify the most common symptoms of LSS; look for the “Shopping Cart Syndrome”
  2. Your interventional pain practice offers minimally invasive options

Patient Education Materials

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.

Word-of-mouth can be one of the most powerful tools to grow your mild® practice. Encourage patients to help advocate on your behalf.

Patient Testimonials

Document patients’ stories and testimonials; record a simple interview on a mobile phone that you can easily post to your website or social media. Showcase their mobility and be sure to obtain permission before posting the testimonial.

Patient Reviews

Encourage patients to share their improvements on review platforms or social media. Remind them that by sharing their story, they are helping others who are in pain find relief like they did.

Recognize LSS in Others

Teach mild® patients how to recognize LSS in their friends and family. They likely know others suffering from their same condition and can educate people in their community about the procedure.

Contact Us

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 mild® Procedure and how its benefits are transforming the lives of patients. Please reach out if you need further assistance in optimizing these resources.

To order patient education marketing materials (brochures, posters, etc.) or to schedule a staff training, please contact your local Vertos representative.

For additional marketing-related questions, please email us at mild@vertosmed.com.

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