Treatments · Minimally Invasive Spine Procedures
MILD (Minimally Invasive Lumbar Decompression)
A minimally invasive procedure that removes small pieces of excess tissue and bone to decompress the spinal canal in patients with stenosis — without an implant and without open surgery.
What it involves
In lumbar spinal stenosis, a thickened ligament (the ligamentum flavum) is often a major contributor to the narrowing that compresses the nerves. Through a small portal — smaller than the diameter of a pencil — Dr. Foster removes small pieces of that excess ligament and bone using specialized instruments under fluoroscopic guidance, directly enlarging the space available for the nerves.
No implant is placed and no bone is cut, which distinguishes MILD from more invasive surgical decompression — it's performed through a small portal with local anesthesia and light sedation, not general anesthesia.
How it works
By directly removing the excess tissue narrowing the canal, MILD addresses the mechanical cause of stenosis symptoms rather than just managing the pain and heaviness that compression produces. Candidates are patients with central stenosis from a thickened ligament specifically — the procedure isn't suited to stenosis driven primarily by bony overgrowth of the facet joints or significant disc bulging.
Because nothing is implanted, MILD doesn't foreclose other options later — patients who don't get adequate relief can still pursue interspinous spacers or surgical decompression afterward if needed.
How We Build Your Plan
The clinical reasoning behind this recommendation
What's the diagnosis?
MRI-confirmed central lumbar spinal stenosis, specifically from ligamentum flavum thickening, in a patient with the classic neurogenic claudication pattern — leg heaviness or cramping with standing and walking, relieved by sitting or leaning forward.
What's the mechanism?
Removing small pieces of the thickened ligament directly enlarges the available space within the spinal canal, addressing the mechanical compression causing symptoms rather than managing the pain it produces.
What are the options?
Conservative care and epidural steroid injections remain the first steps; MILD is considered for appropriate candidates whose imaging shows ligament-driven central stenosis, before interspinous spacers or open surgical decompression.
Why this approach?
Because MILD removes tissue without implanting anything or requiring general anesthesia, Dr. Foster considers it for well-selected patients as a lower-risk, lower-recovery step before more invasive options — provided the imaging confirms the right kind of stenosis for this specific approach.
What are the tradeoffs?
MILD is less invasive than open surgical decompression and doesn't foreclose other options later, but it's suited only to a specific pattern of stenosis — ligament-driven central narrowing — and isn't the right tool for stenosis primarily caused by bony overgrowth or significant disc involvement.
What to Expect
An outpatient procedure with a short recovery
The procedure typically takes about an hour and is done on an outpatient basis with local anesthesia and light sedation — no general anesthesia and no overnight stay for most patients. Because no implant is placed and no bone is cut, recovery is generally faster than open surgical decompression.
Most patients notice some soreness at the small portal site for a few days, with activity gradually increased over the following weeks. Meaningful relief in leg symptoms often builds over several weeks as swelling from the procedure itself settles.
Conditions This Treats
Conditions this treatment addresses
For more information about the MILD procedure, visit the manufacturer's official resource: Stryker mild Procedure.
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