The Minimally Invasive Lumbar Decompression (MILD) procedure is a specialized treatment addressing lumbar spinal stenosis (LSS). This condition involves the narrowing of the spinal canal in the lower back, which compresses the spinal nerves and causes pain, numbness, or cramping in the lower back and legs. The MILD procedure is a non-traditional surgical option that uses a percutaneous approach to alleviate this nerve compression.
Understanding the MILD Procedure
The MILD procedure targets the ligamentum flavum, a thick band of tissue running behind the spinal cord that can thicken as a person ages. When this ligament overgrows and buckles into the spinal canal, it reduces the space available for the nerves, leading to LSS symptoms that typically worsen when standing or walking. The procedure is classified as minimally invasive because it is performed through a tiny incision, often smaller than five millimeters, using only local anesthetic and light sedation.
The mechanism involves the doctor using specialized instruments, guided by fluoroscopy (live X-ray imaging), to access the spine. They remove small portions of the thickened ligamentum flavum and any small pieces of bone that may also be contributing to the narrowing, restoring space in the spinal canal and relieving pressure on the compressed nerves. This technique is an outpatient procedure, typically lasting less than an hour, and patients can often return to their normal activities within 24 hours.
Primary Medical Specialties Who Perform MILD
The medical professionals who perform the MILD procedure generally fall into two main categories: Interventional Pain Management Specialists and certain Spine Surgeons. The nature of the procedure, which involves precise, image-guided access to the epidural space without a large incision, aligns with the skill sets of both groups. However, the procedure is most frequently associated with the interventional pain community.
Interventional Pain Management Specialists are physicians who have completed a residency, most commonly in Anesthesiology or Physical Medicine and Rehabilitation (PM&R), followed by an accredited fellowship in Pain Medicine. Their core training focuses on using fluoroscopic or ultrasound imaging to guide specialized tools for therapeutic procedures within the spine, such as epidural injections and nerve blocks. The MILD procedure is a natural extension of this skill set, requiring expertise in navigating the epidural space and performing precise tissue removal percutaneously.
Spine Surgeons, including Orthopedic Spine Surgeons and Neurosurgeons, also perform the MILD procedure, particularly those whose practice emphasizes minimally invasive spine techniques. These surgeons complete extensive residency training focused on the anatomy and surgery of the entire spine. While they are fully qualified to perform traditional, open decompression surgeries like laminectomies, many have adopted the MILD procedure as a less-invasive option for patients with specific types of LSS. MILD offers these specialists a way to decompress the spinal canal without altering the structural stability of the spine, which is a consideration with more traditional surgical approaches.
Required Training and Certification for MILD Providers
Regardless of a physician’s primary specialty, performing the MILD procedure requires specific, proprietary training and certification. Because the procedure uses a specialized device, the provider must be trained and certified in its proper use. The training ensures the physician understands the specific technical steps for safely guiding the instruments to the precise location of the thickened ligament under fluoroscopic guidance.
This specialized education often involves didactic instruction, hands-on workshops using anatomical models or cadavers, and mentorship from experienced MILD practitioners. Training programs are designed to establish proficiency in patient selection, procedural technique, and post-procedure management. The specific certification process confirms that the physician has met the manufacturer’s standards for competency and authorization to use the procedure’s proprietary instruments.
Locating Certified MILD Practitioners
Patients should look for doctors who have successfully completed the specialized training and certification for the MILD procedure. The most direct method for locating a qualified physician is often through the official provider locator tools maintained by the procedure’s developer. These online resources allow prospective patients to search for certified MILD physicians by geographic location.
When consulting with a potential provider, patients should ask specific questions to verify their experience with the procedure. It is helpful to inquire about the number of MILD procedures the doctor performs annually and their typical patient outcomes. Patients should also confirm the physician’s board certification in their underlying specialty, such as Interventional Pain Medicine, Orthopedic Surgery, or Neurosurgery.