Minimally invasive lumbar decompression (MILD) restores space in the spinal canal by removing small amounts of thickened ligament — improving walking distance and standing tolerance for patients with lumbar spinal stenosis without open surgery or implants.
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Who This May Help
The MILD procedure may be an option if you have lumbar spinal stenosis causing leg pain, heaviness, cramping, or weakness that worsens with walking or standing and improves when you sit down or lean forward. This pattern — called neurogenic claudication — is one of the hallmark symptoms of lumbar stenosis and is what the MILD procedure is specifically designed to address. Candidates typically have MRI confirmation of moderate to severe stenosis with thickening of the ligamentum flavum, and have not found adequate relief through physical therapy, medications, or epidural steroid injections.
A consultation with our clinical team will determine whether you are a candidate.
Procedure Overview
How the MILD Procedure Works
In lumbar spinal stenosis, the ligamentum flavum — a thick ligament running along the back wall of the spinal canal — thickens and buckles inward over time, reducing the space available for the spinal cord and nerve roots. The MILD procedure uses specialized instruments introduced through a very small incision — approximately 6 mm — to remove small amounts of this thickened ligament and any contributing bone, restoring space inside the canal and relieving the pressure on compressed nerves.
No implants are placed and no stitches are required. The procedure is performed using real-time imaging guidance and is a same-day outpatient procedure — patients go home the same day with little to no recovery time compared to open spine surgery.
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Recovery & Results
What to Expect After the Procedure
Recovery from the MILD procedure is significantly shorter than traditional open spine surgery. Most patients go home the same day and resume light daily activities within one to two days. Some mild soreness at the procedure site is normal and resolves quickly. Walking is encouraged soon after returning home.
Many patients notice improvement in their walking distance and standing tolerance within days to weeks of the procedure, with continued gains over the first one to three months. The most common patient experience is being able to walk further and stand longer before leg symptoms develop — meaningfully improving daily function and quality of life.
Frequently Asked Questions
Common Questions
The MILD procedure may be appropriate for patients with lumbar spinal stenosis causing neurogenic claudication — leg pain, heaviness, cramping, or weakness that worsens with walking or standing and improves with sitting or leaning forward. Candidates typically have imaging confirmation of moderate to severe spinal stenosis with ligamentum flavum thickening, and have not found adequate relief through physical therapy, medications, or epidural steroid injections.
Neurogenic claudication is the pattern of leg symptoms caused by lumbar spinal stenosis — pain, heaviness, cramping, or weakness in the legs that develops after walking a certain distance or standing for a period of time, and that relieves when you sit down or lean forward. It is one of the hallmark symptoms of lumbar stenosis and is what the MILD procedure is specifically designed to address.
The MILD procedure removes small amounts of thickened ligamentum flavum — the ligament that runs along the back of the spinal canal and commonly thickens and buckles inward in lumbar spinal stenosis — through a very small incision using specialized instruments. By removing this tissue, space is restored inside the spinal canal and pressure on the compressed nerve roots is relieved. The procedure does not require implants, stitches, or general anesthesia in most cases.
Traditional open spine surgery for stenosis — such as a laminectomy or laminotomy — requires a larger incision, removal of more tissue, and a significantly longer recovery. The MILD procedure achieves decompression through a much smaller incision using specialized instruments, with little to no recovery time and no implants. It is designed for patients who are not ideal candidates for open surgery or who want a less invasive option before considering surgery.
Many patients notice improvement in their walking distance and standing tolerance within days to weeks of the procedure. The full benefit continues to develop over the first one to three months. Most patients experience a meaningful improvement in their ability to walk and stand without the leg pain and heaviness that previously limited their activity.
The MILD procedure is covered by Medicare for appropriately selected patients with lumbar spinal stenosis and neurogenic claudication. Coverage by commercial insurance plans varies. Our team will review your imaging, clinical history, and insurance coverage at your consultation.
Trouble Walking or Standing? Let’s Talk.
Our clinical team will evaluate your imaging and symptoms to determine whether the MILD procedure is an appropriate option for your spinal stenosis.
