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Minimally Invasive Lumbar Decompression

Minimally invasive lumbar decompression (M.I.L.D.) is a new procedure recently approved by the FDA for clinical use.  At a time when great frustration exists regarding the explosion of maximally invasive , and often ill-advised, multi-level surgical fusions it is indeed refreshing to see a relatively simple and cost-effective procedure being introduced which, if not effective, can then be addressed with more invasive surgeries

As with most surgical procedures careful patient selection is essential.  Patients who are candidates for M.I.L.D. are typically older individuals who have developed nerve compression secondary to central spinal stenosis and have developed lumbar claudication syndromes secondary to this.  The typical presentation is that of an inability to walk more than a short distance without leg pain due to nerve compression.

Shown below is an actual pathologic specimen demonstrating central spinal stenosis (narrowing of the central spinal canal secondary to disc degeneration) as well as a CT scan illustrating a typical case.  The green dot shows where there has been thickening of the fibrous ligamentum flavum (yellow ligament).  A simple reduction in the volume of this ligament is often sufficient to produce clinical relief of pain and associated disability.


The M.I.L.D. procedure is typically performed in the operating room under fluoroscopic control.  Through a small skin incision the surgeon inserts a instrument and guides it to the target area where specialized mini-instruments remove some of the fibrous tissue.  The radiograph below shows one of the instruments in place where the epidural space has been previously outlined by the injection of dye to serve as a landmark.
Operative images courtesy of Vertos Medical (www.vertosmed.com)

In many cases of chronic nerve compression it may require only a slight
amount of decompression to relieve the disabling clinical problem.  M.I.L.D. is clearly a step in the right direction in decreasing patient risk and in promoting more cost-effective health care.