August 2019 Edition. Volume XIX

Minimally invasive lumbar decompression, the MILD. procedure was a FDA approved procedure.  MILD promised to be a relatively simple and cost effective image guided procedure  which, if not effective, could then be addressed with more invasive surgeries MILD had the potential to be cost-effective but because it required a high level of technical training and ability on the part of the procedurist employing it it “fell into disuse“. The actual procedure is discussed below:

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 illustrates 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.

Path CSS Dot 250p  Radiograph CSS

The MILD procedure was 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 MILD instruments in place where the epidural space has been previously outlined by the injection of dye to serve as a landmark.

Op Photo 300p

Operative images courtesy of Vertos Medical (

Op Fluoro 300p

Operative images courtesy of Vertos Medical (


In many cases of chronic nerve compression it required only a slight amount of decompression to relieve the disabling clinical problem. Theoretically MILD was a productive step in the right direction in decreasing patient risk and in promoting more cost-effective health care.  It will remain for the future for Spine Specialist Invasive Radiologists to step up to this plate.

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