MILD (Minimally Invasive Lumbar Decompression) in Castle Rock
What is the MILD Procedure?
MILD stands for Minimally Invasive Lumbar Decompression. It is an outpatient procedure used to treat lumbar spinal stenosis caused by thickened ligamentum flavum - the ligament that runs along the back of the spinal canal. When this ligament thickens with age, it takes up space in the spinal canal and compresses the nerves. MILD removes small amounts of bone and excess ligament tissue to restore space for the nerves, reducing pain and improving the ability to stand and walk.
MILD fills an important gap in the treatment of spinal stenosis. It is more targeted than epidural steroid injections, which only reduce inflammation temporarily, but far less invasive than surgical decompression (laminectomy). There are no implants, no stitches, and no general anesthesia required.
Who is a Candidate for MILD?
MILD is specifically designed for patients with lumbar spinal stenosis who have neurogenic claudication - a pattern of leg pain, heaviness, numbness, or weakness that gets worse with standing and walking and improves with sitting or bending forward. Candidates typically have:
Moderate to severe lumbar spinal stenosis confirmed on MRI
Thickened ligamentum flavum (2.5 mm or greater) at the affected level(s)
A classic claudication pattern: symptoms worsen with standing and walking, improve with sitting or leaning forward
Functional limitations affecting daily activities - difficulty walking through a store, standing in line, or going for a walk
Failure of conservative treatments including physical therapy, medications, and epidural steroid injections
MILD is not appropriate for all types of spinal stenosis. If the narrowing is caused primarily by a large disc herniation or bony overgrowth rather than ligament thickening, other treatments may be more appropriate. Dr. Carrera's team reviews your MRI to determine whether MILD is a good option for your specific anatomy.
How is MILD Different from Epidural Steroid Injections?
Epidural steroid injections deliver anti-inflammatory medication into the spinal canal to reduce swelling around compressed nerves. They can provide temporary relief, but they do not change the underlying narrowing. Many patients need repeat injections every few months.
MILD physically removes the tissue that is causing the narrowing. By debulking the thickened ligament and removing small amounts of bone, the procedure creates more room for the nerves. The result is structural improvement, not just inflammation control. For patients whose stenosis is driven by ligamentum flavum hypertrophy, MILD addresses the root cause in a way that epidurals cannot.
How is MILD Different from Surgery (Laminectomy)?
A laminectomy is an open surgical procedure that removes a larger portion of the vertebral bone to decompress the spinal canal. It is performed under general anesthesia, can require a hospital stay, and has a longer recovery period. Laminectomy is highly effective for severe stenosis but carries higher surgical risk.
MILD is performed through a small incision (about the size of a pencil eraser) using specialized instruments under fluoroscopic guidance. There is no general anesthesia - the procedure is done under IV sedation (monitored anesthesia care). There are no implants and no stitches. Most patients go home the same day and resume light activities within a few days.
For patients with moderate stenosis driven by ligament thickening, MILD can provide meaningful improvement in walking and standing ability without the risks and recovery time of open surgery.
What Results Can I Expect from MILD?
Published research on MILD shows significant improvements in both pain and function:
In the MiDAS ENCORE study, patients reported an average pain improvement of 3.6 points (on a 0-10 scale) at two years, and 77% of patients reported satisfaction with the procedure.
In a separate prospective study, average standing time improved from 8 minutes to 56 minutes, and average walking distance improved from 246 feet to nearly 4,000 feet.
Individual results vary. Some patients notice improvement within weeks, while for others it develops gradually over several months. The goal is to improve your ability to stand and walk comfortably - not necessarily to eliminate all pain.
How Should I Prepare for MILD?
Dr. Carrera's team will review your preparation instructions before the procedure. General guidelines include:
Blood thinners and certain medications may need to be stopped temporarily. The team will provide specific instructions based on your medications.
Do not eat or drink for several hours before the procedure (specific timing will be provided).
Arrange for someone to drive you home after the procedure.
Wear comfortable clothing.
Pre-operative antibiotics are given before the procedure to reduce infection risk.
What Happens During the MILD Procedure?
You will lie face down on a procedure table. IV sedation is administered to keep you comfortable and relaxed. The skin over your lower back is cleaned and numbed.
Using fluoroscopy (live X-ray) for guidance, a small incision is made and specialized instruments are inserted to the affected level. Small amounts of bone and thickened ligamentum flavum are carefully removed to create more space in the spinal canal. The procedure is repeated at each affected level. When complete, the small incision is closed with adhesive strips - no stitches are needed.
The procedure typically takes about 30 to 60 minutes depending on how many levels are treated.
What Should I Expect After MILD?
Most patients go home the same day. Expect some localized soreness and mild bruising at the procedure site for several days. This is normal.
Recovery guidelines:
Avoid repetitive bending, twisting, and lifting more than 10 pounds for about two weeks.
Gradually return to normal activities as tolerated.
Physical therapy may be started about two weeks after the procedure to help rebuild strength and mobility.
Improvement in walking and standing tolerance may begin within weeks and can continue to develop over several months.
What Are the Risks of MILD?
Serious complications from MILD are uncommon. In the MiDAS ENCORE study, only 1.3% of patients experienced a procedure-related adverse event. Risks include infection, bleeding, dural puncture (a tear in the membrane around the spinal cord that can cause a headache), nerve injury, worsening symptoms, and risks associated with sedation. Dr. Carrera's team reviews these risks with you in detail before the procedure.
Does Insurance Cover MILD?
MILD is covered by Medicare and many commercial insurance plans for patients with lumbar spinal stenosis who meet specific criteria. These typically include confirmed stenosis on MRI with ligamentum flavum hypertrophy, neurogenic claudication symptoms, and failure of conservative treatments. Prior authorization is required.
Dr. Carrera's team handles prior authorization and insurance verification so you and your referring provider do not have to manage that process.
Where Does MILD Fit in the Treatment of Spinal Stenosis?
The typical treatment progression for lumbar spinal stenosis looks like this:
1. Conservative care: Physical therapy, activity modification, and medications.
2. Epidural steroid injections: Reduce inflammation and provide temporary relief. May be repeated if effective.
3. MILD: For patients with ligamentum flavum hypertrophy whose symptoms persist despite epidurals. Removes the tissue causing the narrowing without surgery or implants.
4. Spinal cord stimulation: For patients with persistent nerve pain who are not candidates for or have not responded to other treatments.
5. Surgical decompression (laminectomy): For severe stenosis with progressive weakness, significant numbness, or failure of less invasive options.
MILD occupies the space between injections and surgery. For the right patient, it can provide meaningful functional improvement while avoiding the risks and recovery of an open operation.
For Referring Providers
If you are referring a patient for MILD evaluation, fax the referral to 720-455-3776 along with recent lumbar MRI reports. Ideal candidates have moderate to severe lumbar stenosis with ligamentum flavum hypertrophy and a classic neurogenic claudication pattern. Dr. Carrera's team will review imaging, confirm candidacy, and handle prior authorization.
For questions about whether a specific patient is a good candidate, call 720-455-3775 directly.
Patients in Castle Rock, Lone Tree, Parker, Highlands Ranch, Denver, Colorado Springs, and surrounding areas can call 720-455-3775 to schedule an evaluation.
Call 720-455-3775 to schedule an appointment