The durability of minimally invasive lumbar decompression procedure in patients with symptomatic lumbar spinal stenosis: Long‐term follow‐up

Mekhail, Nagy; Costandi, Shrif; Nageeb, George; Ekladios, Catherine; Saied, Ogena

doi:10.1111/papr.13020

Cited by 14 publications

(20 citation statements)

References 20 publications

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“…This rate is consistent with the 5.2% rate reported for an earlier study of the mild treatment at 2-year follow-up [35]. At 5-year follow-up, a reported 12% rate of subsequent surgical decompression indicates a low 2.4% per year rate of surgery after treatment with mild [22]. Conversely, systematic reviews of multiple randomized trials comparing ESIs with placebo injections have concluded that the efficacy of spinal injections is limited and that ESIs do not reduce the rate of subsequent surgery [38].…”

Section: Discussionsupporting

confidence: 89%

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Minimally Invasive Direct Decompression for Lumbar Spinal Stenosis: Impact of Multiple Prior Epidural Steroid Injections

Pryzbylkowski¹,

Bux

Chandwani

et al. 2021

Pain Manag.

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Background: A modified algorithm for the treatment of lumbar spinal stenosis with hypertrophic ligamentum flavum using minimally-invasive lumbar decompression ( mild®)was assessed, with a focus on earlier intervention. Patients & methods: Records of 145 patients treated with mild after receiving 0–1 epidural steroid injections (ESIs) or 2+ ESIs were retrospectively reviewed. Pain assessments as measured by visual analog scale (VAS) scores were recorded at baseline and 1-week and 3-month follow-ups. Results: Improvements in VAS scores at follow-ups compared with baseline were significant in both groups. No statistically significant differences were found between the two groups. Conclusion: Multiple ESIs prior to mild showed no benefit. A modified algorithm to perform mild immediately upon diagnosis or after the failure of the first ESI is recommended.

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Section: Discussionsupporting

confidence: 89%

“…The mild procedure has been previously described in detail [20]. This treatment has been shown to provide statistically superior efficacy compared with ESIs at follow-up intervals ranging from 6 months to 1 year [21], and strong durability for the relief of LSS symptoms over 5 years [22].…”

mentioning

confidence: 99%

Minimally Invasive Direct Decompression for Lumbar Spinal Stenosis: Impact of Multiple Prior Epidural Steroid Injections

Pryzbylkowski¹,

Bux

Chandwani

et al. 2021

Pain Manag.

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“…Importantly, there were no serious device‐ or procedure‐related adverse events and only 5.6% (8 of 143 patients total) required spinal surgery at the levels of the MILD procedure over the 2‐year follow‐up time period 14 . Mekhail et al reported the incidence of open lumbar decompression surgery at the same levels as the MILD procedure during 5‐year follow‐up was 12% (9 of 75 patients total) 15 . Similarly, when considering Superion, Nunley et al reported that 75% of patients randomized to receive Superion for treatment of lumbar spinal stenosis remained free from reoperation, revision, or supplemental fixation at the treated level at 5 years post‐implant 16 …”

Section: Discussionmentioning

confidence: 99%

The incidence of lumbar spine surgery following Minimally Invasive Lumbar Decompression and Superion Indirect Decompression System for treatment of lumbar spinal stenosis: a retrospective review

Hagedorn¹,

Yadav

D’Souza

et al. 2022

Pain Practice

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Introduction: Lumbar spinal stenosis affects more than 200,000 adults in the United States, resulting in approximately 38,000 operations among the Medicare population and greater than $1.5 billion in hospital bills alone. Fortunately, Minimally Invasive Lumbar Decompression (MILD) and the Superion Indirect Decompression System have shown lasting benefit and cost savings compared to more aggressive surgical options.Objective: Our primary objective was to retrospectively determine the rate of lumbar decompression surgery following the MILD and Superion procedures. Materials and Methods:This was a pooled retrospective review of LSS patients who received MILD and/or Superion procedures between January 2011 and July 2019. Adult patients with CPT codes for MILD and Superion procedures were identified. Patients were included if they had a follow-up visit at least 2 years from the procedure date, preprocedural MRI results, and surgical notes. Results: A total of 199 patients were included in the final analysis, of which 57 patients (28.6%) underwent MILD procedure only, 124 patients (62.3%) underwent Superion only, and 18 patients (9.0%) underwent an MILD procedure initially followed by a Superion procedure. Two patients had an MILD procedure performed twice at the same level at separate encounters. A total of four patients in the entire cohort (2.0%; MILD 5.3%, Superion 0.8%) underwent subsequent lumbar spine surgery when followed for at least 2 years. It is notable that some of these patients may not have been surgical candidates and this may have skewed the results. Conclusions: Patients undergoing minimally invasive decompression treatment of lumbar spinal stenosis have low rates of subsequent open surgery which potentially results in cost savings and a reduction in severe adverse events. The reason for low surgical rate may reflect improvement in their symptoms, a preference to avoid surgery, or being deemed not a surgical candidate.

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“…PILD was developed in 2005 as an alternative for cancer patients considered too high risk for open surgical decompression, and has evolved to label indications for direct decompression at spinal levels L1-S1 for symptomatic LSS with two level 1 RCTs, 61 , 62 several level II prospective controlled studies, 63–66 and a 5-year retrospective longitudinal observational durability study demonstrating statistically significant improvement in pain and mobility. 67 …”

Section: Percutaneous Image-guided Lumbar Decompression (Pild)mentioning

confidence: 99%

“…The study further evaluated opioid use and pain relief, finding that the initial results reported were durable throughout the 5-year period. 67 …”

Section: Percutaneous Image-guided Lumbar Decompression (Pild)mentioning

confidence: 99%

Best Practices for Minimally Invasive Lumbar Spinal Stenosis Treatment 2.0 (MIST): Consensus Guidance from the American Society of Pain and Neuroscience (ASPN)

Deer¹,

Grider²,

Pope³

et al. 2022

JPR

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Introduction Lumbar spinal stenosis (LSS) is a common spinal disease of aging with a growing patient population, paralleling population growth. Minimally invasive treatments are evolving, and the use of these techniques needs guidance to provide the optimal patient safety and efficacy outcomes. Methods 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. Results The world literature in English was searched using Medline, EMBASE, Cochrane CENTRAL, BioMed Central, Web of Science, Google Scholar, PubMed, Current Contents Connect, Scopus, and meeting abstracts to identify and compile the evidence (per section) for LSS-related pain. Search words were selected based upon the section represented. Identified peer-reviewed literature was critiqued using USPSTF criteria and consensus points are presented. Discussion The algorithm for patient selection in the management of symptomatic spinal stenosis is evolving. Careful consideration of patient selection and anatomic architecture variance is critical for improved outcomes and patient safety. Conclusion ASPN created a guidance for best practice for minimally invasive surgical treatment of symptomatic spinal stenosis.

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The durability of minimally invasive lumbar decompression procedure in patients with symptomatic lumbar spinal stenosis: Long‐term follow‐up

Cited by 14 publications

References 20 publications

Minimally Invasive Direct Decompression for Lumbar Spinal Stenosis: Impact of Multiple Prior Epidural Steroid Injections

Minimally Invasive Direct Decompression for Lumbar Spinal Stenosis: Impact of Multiple Prior Epidural Steroid Injections

The incidence of lumbar spine surgery following Minimally Invasive Lumbar Decompression and Superion Indirect Decompression System for treatment of lumbar spinal stenosis: a retrospective review

Best Practices for Minimally Invasive Lumbar Spinal Stenosis Treatment 2.0 (MIST): Consensus Guidance from the American Society of Pain and Neuroscience (ASPN)

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