Minimally invasive decompression
MILD Lumbar Decompression
A tissue-sparing option for selected lumbar stenosis
MILD—also called percutaneous image-guided lumbar decompression—removes small portions of thickened ligament that contribute to lumbar spinal stenosis and walking-related leg symptoms.
This guide is educational and cannot determine candidacy. Every treatment has limitations and risks, and outcomes are not guaranteed. A clinician must review your diagnosis, health history, imaging, medicines, and goals.
What it targets
A procedure built for a particular pain mechanism.
The ligamentum flavum lines the back of the spinal canal and can thicken with degeneration. In selected patients, it contributes to crowding of the nerves and neurogenic claudication: leg discomfort, heaviness, numbness, or weakness that worsens with standing or walking and improves with sitting or leaning forward. MILD creates additional space without placing an implant.
Who may be evaluated
Candidacy begins with diagnostic fit.
The procedure addresses a particular contributor to stenosis. It does not correct every cause of canal narrowing, instability, disc herniation, or progressive neurologic deficit.
Clinical considerations
- Lumbar spinal stenosis with neurogenic claudication
- MRI evidence that hypertrophied ligamentum flavum contributes to the narrowing
- Persistent walking or standing limitation after appropriate conservative care
- No urgent indication for open decompression or another corrective operation
- Medical suitability for an outpatient image-guided procedure
Evaluation may include
- History focused on walking tolerance, posture dependence, and neurologic symptoms
- Neurologic examination and updated lumbar MRI
- Review for instability, severe weakness, bowel or bladder changes, and other surgical red flags
- Medication review, particularly anticoagulants and antiplatelet agents
How it is performed
The procedure, step by step.
Level confirmation
Imaging and symptoms are reviewed to select the stenotic level where ligament thickening is a meaningful contributor.
Percutaneous access
Under local anesthetic, light sedation, and X-ray guidance, a small portal is advanced to the back of the lumbar canal.
Targeted decompression
Specialized instruments remove small portions of ligament and, when needed, a limited amount of adjacent bone to increase canal space.
After the procedure
Recovery, follow-up, and important risks.
Recovery & follow-up
- Patients commonly return home the same day after a brief observation period.
- Light activity may resume over several days according to the postoperative plan.
- Walking and rehabilitation are advanced gradually; the pace of improvement differs among patients.
- Follow-up monitors walking tolerance, leg symptoms, neurologic function, and the need for additional care.
Risks & limitations
- Bleeding, infection, dural tear, spinal fluid leak, or epidural hematoma
- Nerve or spinal canal injury and worsening neurologic symptoms
- Insufficient decompression if other structures dominate the stenosis
- Persistent symptoms that later require another procedure or surgery
Alternatives to discuss
Evidence & technology
What is established—and what is still being studied.
Evidence in context
Clinical studies support improvement in function and claudication for selected patients. Medicare coverage has historically been tied to Coverage with Evidence Development requirements, and current eligibility must be verified rather than assumed.
Brands are examples, not endorsements
mild is the trade name commonly associated with the specialized instrument set; the broader clinical term is percutaneous image-guided lumbar decompression. Mention of the brand is descriptive, not an endorsement over every alternative.
Common questions
A useful conversation starts here.
Related patient guides
Compare nearby clinical pathways.
Bring the questions with you
Find out whether the diagnosis fits the treatment.
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