William Witt, MD, the medical director of Cardinal Hill Pain Institute in Lexington, Ky., answers questions about mild procedure as treatment for lumbar spinal stenosis.
Q: What is involved in the learning curve for physicians interested in making mild a part of their practice?
Dr. William Witt: The most important part of the procedure is having a familiarity with interpreting fluoroscopic images to three-dimensional anatomy. Interventional pain specialists and interventional radiologists are experienced in this area since most procedures they perform require this specialized skill. The mild procedure technique is very straightforward and can be mastered after completing a company-sponsored cadaver course and after the first few cases the physician will become thoroughly comfortable with doing the procedure.
Q: How should physicians screen patients and select appropriate candidates for the procedure?
WW: Appropriate patient selection begins with a review of the patient symptoms followed by MRI confirmation of the diagnosis. Patients with lumbar spinal stenosis with neurogenic claudication are typically over the age of 50 and are experiencing symptoms of pain in the lower back, legs or buttocks when standing or walking that is relieved by sitting or leaning forward. The neurogenic claudication symptoms can be confirmed with MRI and if patients have hypertrophic ligamentum flavum as a predominant factor of their LSS, even in the presence of other factors including disc bulge and osteophytes, they can be treated with mild.
Q: How should physicians explain the procedure to patients apprehensive about undergoing mild in the outpatient setting?
WW: For a procedure to be performed in an outpatient setting, it must be extremely safe. The mild procedure is performed through a 5.1 mm portal which allows for minimal tissue disruption and does not require general anesthesia, implants or even stitches. Recovery is quick; patients can walk out of the hospital or ASC and resume activities within days. Fluoroscopic guidance ensures continuous safety, the instruments do not enter the spinal canal and all activity is posterior to the dura. The mild procedure has a truly outstanding safety record, no major complications including dural tear, nerve root damage or blood loss requiring transfusion have been reported in clinical trials.
Q: How do you think this procedure will evolve over time?
WW: I think mild will become a first-line treatment for LSS patients as it is safe, effective, cost-effective and well-aligned with future healthcare trends. mild fills a gap in the historic treatment algorithm of LSS by providing a minimally invasive treatment option that can be offered to patients before open spine surgery and since mild maintains the structural stability of the spine it does not limit open surgical treatment should that be necessary. As the prevalence of LSS increases with the aging baby boomer generation the demand for mild will continue to rise.
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