Caught between conservative care and a large spine surgery, the MILD procedure offers potential as the in-between. On this episode of the BackTable MSK Podcast, Interventional Radiologist Dr. Dana Dunleavy welcomes pain specialist Dr. Denis Patterson to explore the evidence, technique, and evolving role of Minimally Invasive Lumbar Decompression (MILD) procedure for lumbar spinal stenosis with neurogenic claudication.

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This podcast is supported by

Stryker
https://www.stryker.com/us/en/interventional-spine/products/mild-procedure.html

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Timestamps

00:00 - Introduction
04:22 - What is the MILD procedure?
09:55 - Comparing Discogenic Pain to Neurogenic Claudication
19:20 - MILD Procedure Technique
22:54 - Toolbox and Workflow
36:59 - MILD Makes a Difference in the Pain Management Field
41:53 - Objectifying Pain Measurements and Setting Patient Expectations
46:26 - Driving Mutual Understanding in Surgical Cohorts
01:00:53 - Collaboration Over Competition
01:05:32 - Final Takeaways

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More about this episode

Dr. Patterson explains the pathophysiology and diagnostic process, highlighting key insights from patient history and MRI findings. The physicians review technique evolution from multiple paramedian incisions and epidurograms to streamlined single midline incision access, and cross lateral oblique (CLO) fluoroscopic safety landmarks.

The discussion also references the MiDAS and Cleveland Clinic studies showing pain and functional improvement with a complication rate similar to epidural steroid injections, along with promising long-term outcomes and reduced need for surgical re-intervention. This episode also tackles practical considerations, including the impact of Category I CPT codes on reimbursement, challenges in radiology reporting, privileging politics, and pathways for physician training and proctoring.

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Resources

Dr. Denis Patterson
https://www.linkedin.com/in/denis-patterson-50ba0485/

MiDAS I (Mild Decompression Alternative to Open Surgery): a preliminary report of a prospective, multi-center clinical study
https://pubmed.ncbi.nlm.nih.gov/20648206/

The durability of Minimally Invasive Lumbar Decompression procedure in patients with symptomatic lumbar spinal stenosis: Long-term follow-up
https://pubmed.ncbi.nlm.nih.gov/33942964/

Pacific Spine and Pain Society
https://pacificspineandpainsociety.com/

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BackTable Musculoskeletal (MSK) is the go-to podcast for musculoskeletal radiologists, interventional pain specialists, and orthopedic surgeons.

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Ep. 97 Minimally Invasive Lumbar Decompression (MILD): Techniques & Outcomes with Dr. Denis Patterson