Vertos Medical Blog

The Top 5 Reasons Practices Are Moving to mild® After the First ESI Fails

Published July 21, 2021

Today, an increasing number of practices recommend their patients move to mild® after the first epidural steroid injection (ESI) fails, and it’s easy to see why. mild® provides patients relief from the symptoms of lumbar spinal stenosis (LSS) and has a safety profile equivalent to an ESI, but with lasting results. In the following article, we present the most common reasons physicians and Advanced Practice Providers (APPs) are moving their patients to mild® earlier in the treatment journey.

Ready to move to mild®? Skip to the end for 3 pragmatic solutions you can implement in your practice today to get started, and get your patients on the path to relief.

5-year durability


A recently published study conducted by the Cleveland Clinic Study explores how many patients were able to avoid surgical decompression after the mild® Procedure over a five-year period.

The data showed that 88% of patients avoided surgical decompression for at least 5 years.

The study authors concluded that “the durability of mild® over 5 years may allow elderly patients with symptomatic lumbar spinal stenosis to avoid lumbar decompression surgery while providing significant symptomatic relief.” They also noted that “because the mild® Procedure demonstrated durability up to 5 years, it might also be speculated with caution, that appropriate patients should be encouraged to undergo the mild® Procedure as early as needed, rather than waiting until these patients are at an advanced age.”

mild® removes the problem and leaves nothing behind

No implants. mild® removes a major root cause of neurogenic claudication by debulking the hypertrophic ligamentum flavum, which reduces the compression of the nerves without leaving any implants behind.

No stitches. The entire procedure can be performed through a single, tiny incision the size of a baby aspirin (5.1mm).

Image showing how the mild® procedure does not limit future treatment options for lumbar spinal stenosis

mild® does not significantly alter the structural anatomy of the spine or eliminate future treatment options

Safety profile equivalent to an ESI

mild® offers a clinically proven safety profile equivalent to an ESI, even in patients with comorbidities.,

No device- or procedure-related serious adverse events or complications have been reported in any clinical trial.

Patients typically resume normal activity within 24 hours with no restrictions

Unlike more invasive procedures that can require a lengthy recovery, mild® patients typically resume normal activity within 24 hours with no restrictions.

mild® procedure testimonial - Nicky

“When I went for the procedure, it was any other day. I went into the procedure. You feel nothing, and then you come back and you’re fine. I mean, it’s no big deal. There’s no pain, there’s no recovery, you just go home.”

-Nicky, mild® Patient

mild® procedure testimonial - Ronnie

“By the time I walked out [after the mild® Procedure], I went home, and I could get out. The first thing I wanted to do was start doing stuff. That was a big moment in my life emotionally.”

-Ronnie, mild® Patient

Avoids Epidural Exhaustion

LSS patients who receive a series of epidural injections may become frustrated or start to lose hope if the injections provide little relief or decreasing relief over time. While ESIs can sometimes deliver transient, temporary relief, they do not address the root cause of stenosis. The mild® Procedure decompresses, debulking the hypertrophied ligament, to reduce spinal canal narrowing, giving patients a new option to achieve long-term relief.

Featured Data: Long-Term Effects of Repeated Injections of Local Anesthetic With or Without Corticosteroid for Lumbar Spinal Stenosis: A Randomized Trial

Janna L. Friedly et al. studied the long-term effectiveness of ESIs for LSS and the effect of repeat injections. The trial concluded that repeated epidural injections offer no additional benefit if injections in the first 6 weeks did not improve pain.

Alexander Escobar, MD

Physician perspective: Alexander Escobar, MD

“If the patient has received ESIs in your practice and the outcomes were not efficacious, there is no reason to offer them another one. If a patient comes to you from another practice, and has recent history of epidural steroid injections, move to mild®. They’re likely seeking an alternate option, and mild® is something that can provide them hope.”

mild® procedure testimonial - Lynn

Patient perspective: Lynn, mild® Patient

“The first epidural lasted about three months and then the pain was back. I went for the second epidural, and it didn’t last two weeks. My physician said, ‘Well, you can have one more.’ I said, ‘No, I’m finished with them, I want the mild® Procedure.’”

Ready to move to mild®?

Here are a few tips to help you successfully integrate mild® into your practice.

1. Look for the ligament, it’s a common problem

Image showing hypertrophic ligamentum flavum (HLF) >= 2.5mm

When reviewing a patient’s MRIs/CTs, be sure to identify hypertrophic ligamentum flavum (HLF). HLF ≥ 2.5 mm can be readily identified and is surprisingly common, contributing to up to 85% of spinal canal narrowing.

2. Present mild® in initial ESI treatment plan

Introducing patients to mild® early in their treatment journey can help them feel assured that they have effective options if ESIs don’t provide the relief they need. Dr. Jason Pope of the Evolve Restoration Center confirms, “By presenting mild® as part of the treatment plan from the start, patients have more confidence that we are going to be proactive in their care, and make sure they have the opportunity to access advanced LSS treatment options that offer excellent outcomes.”

3. Engage APPs in patient identification and treatment planning

Many practices that offer mild® ensure that physicians and Advanced Practice Providers (APPs) alike are trained to identify patient candidates who may benefit from the mild® Procedure. Jane Hartigan, an APP in a leading Northern California pain management practice recommends asking proactive questions like, “Does hunching forward significantly relieve the pain you’re feeling?”, or “Do you feel pain in your back and legs when standing or walking?” By understanding your patient’s current experience with LSS, their treatment history, and functional goals, you can readily spot the many patients in your practice who may benefit from the mild® Procedure.

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