MILD (minimally invasive lumbar decompression)

[bhoferp]

I have had pain in my lower left leg since before Thanksgiving. I have done physical therapy (including dry needling), tried prednisone and muscle relaxers, as well as hydrodone, an inversion table, an MRI and had my second steroid injection yesterday. My pain doctor says I have spinal stenosis, arthritis of the spine, and a bulging disk. If this spinal injection doesn't work, he is suggesting MILD. Have you had this procedure or know anyone who has and with what results?


I have managed to get my pain level from 9 down to a 4 out of 10, but feel pretty ragged by the end of the day. I will be 74 in a few days and am otherwise in excellent health and don't take any prescriptions on a daily basis. Would you do the MILD procedure if you were in my position?

[MrsHaloFIRE]

Im told all back surgery is a chance of 33.3pct. 33.3 pct you will be better, same odds for getting worse or staying the same. (My PCM, 2020, when she told me to ice and ibuprofen until I could get up off the floor and get my butt moving. Mri was a mess. ) I dont like the 66pct chance of surgical risk AND being sane or possibly worse.

[bhoferp]

My doctor said 50% of people have a 50% reduction in pain. Even those odds don't seem that good to me. I believe my pain doctor is one of the best in our metro area. I asked him if his mother had the same conditions I have if he have her do the MILD procedure and and he said "certainly". I feel like I have been on a hamster wheel for all these months, but I am just tired of having the pain every day.

[npage]

Has he brought up a lumbar RFA ablation? Has helped me a lot with facet joint arthritis,disc degeneration and general back pain. I have multiple things going on MRI and someday surgery likely but no one thing at moment they can say yes if we do X will help.

How well ablation works and for who seems to vary like everything but low risk high reward for many. As you know back issues are very person specific and most answers are degrees of suck vs. how much life sucks if you do nothing choices.

[bhoferp]

He has not mentioned lumbar RFA ablation. Thanks for mentioning it. I will research it some and see what he thinks.

[npage]

Some pain management people don't do them or have little experience so may not bring up. Find someone who does a lot of them, experience matters on these. You want someone who does 100's if not 1000's a year. Not just a side hobby.

Everyone's back issues are so different. It's such a mystery at times, you can have people with no disc or bulging right into cord and no pain and others with almost normal MRI's with tons of pain and everything in between.

In my case a lot of my issues come from facet joint arthritis which these ablations work the best for. They do a couple specific test injections right at the joints to test for results as a screen to determine if they think ablation will work.

[JoeWras]

Quote:

Originally Posted by MrsHaloFIRE Im told all back surgery is a chance of 33.3pct. 33.3 pct you will be better, same odds for getting worse or staying the same. (My PCM, 2020, when she told me to ice and ibuprofen until I could get up off the floor and get my butt moving. Mri was a mess. ) I dont like the 66pct chance of surgical risk AND being sane or possibly worse.

You will hear all kinds of things about back surgery, including horror stories. I've never heard the 1/3 percentage. Who told you? It is also important to understand that some procedures have less chance of success than others. Not all back surgery is equal. Some are 90% (about the best I've seen), some are 50%. Perhaps that's where the 66% comes from. Cut the difference. And npage has a good point about experience of the doctor. My doctor did over 1000 of my procedure before he did mine. Experience matters.

Quote:

Originally Posted by bhoferp My doctor said 50% of people have a 50% reduction in pain. Even those odds don't seem that good to me. I believe my pain doctor is one of the best in our metro area. I asked him if his mother had the same conditions I have if he have her do the MILD procedure and and he said "certainly". I feel like I have been on a hamster wheel for all these months, but I am just tired of having the pain every day.

Thanks for bringing this up. I never heard of MILD. Looking at the promo material, I can see how it may not help everyone because it is so non-invasive. There just isn't a lot of material removed. It looks very promising for the right indicated cases, however. You have to sometimes trust your doctor based on their experience if this is indicated for you. And since it is so non-invasive, it won't eliminate your choices in the future. Good luck and I hope it works out!

My story is simply that back surgery gave me my life back. That's the TL/DR. Sometimes you need the surgery. I'm sorry if that goes against the "never surgery" opinions I always see. Until you walk in someone's shoes that have constant 8 to 10 pain every day, you don't know.

I had suffered with sciatica for 30 years. I managed it with exercise, weight control, occasional ibuprofen, etc. all that time. It would come and go until one day, it didn't go away. I spent a solid year doing all the conservative stuff: exercise, PT, hot, cold, steroids, etc. Many times, your body re-absorbs the stuff (swollen ligaments, disc) causing issues. Tissues shrink and the problem is solved. This is why I don't think it is ever wise to get surgery unless you've spent a solid year trying other things.

Over my last year of constant pain, it took me 10 months until I even got an MRI. That might have been foolish because the radiation techs sat me down and asked me if I was OK to drive home. I told them of course I was, why do you ask? They answered, "Oh, your doctor will call you."

My doctor was stunned by the MRI and said that my brain adapted over the 30 years of on and off problem. I would post my MRI here but I'd rather not put something so personal up here. Suffice it to say, a lay-person could see the problem from across the room. My spinal cord was 75% compressed by the stenosis.

I decided on a bilateral hemilaminotomy. That's still not very invasive compared to open back surgery, but it is way more aggressive than MILD. I still have bone structure to hold me up. I had no implants or fusion. Since surgery, I've given up all jumping sports and running. I also limit my lifting and am very careful in how I do lift. I try to keep lifting anything to a minimum of 50 lbs. Otherwise, I can do pretty much anything and I don't even have spells of sciatica anymore.

For me, it was a 6 month recovery. Really, it was only 4 weeks of being super careful, but I'm glad I didn't do anything aggressive for 6 months. I slowly ramped up.

Near the end, before surgery, I nearly passed out from a sneeze. It was true level 10 pain. Most of the pain was actually in my calf. Sciatica is funny that way. Sneezes were very dangerous when driving. I almost ran off the road. It was that bad. That was the 10 pain. The 8 to 9 pain was just me standing up. At work we had "stand up" meetings. I had special permission to sit. I just couldn't stand without gasping for air from the pain.

So, yeah, surgery gave me my life back.

[harllee]

My story is similar to Joe's. I had a skiing injury as a young person which resulted in a herniated disc. I tried most every treatment and was in terrible pain, barely able to walk or function for about a year. I finally gave up and had the surgery-a discectomy and I was immediately better. I had to do PT to get the numbness out of my leg and foot but I would label my surgery as 100% success.

Since then I continue to do physical therapy for my back. One thing I have done in recent years that help for occasional back pain that I don't think the OP mentioned is TENS machine. Tens machines are inexpensive (I got a very good rechargeable one on Amazon less than $50) and they help with all sorts of muscle/nerve pain.

[HawkeyeNFO]

I've heard the 33.3% deal, from a pain management doctor. I've got plenty of spinal disc issues, as do most people who have flown tactical military aircraft or helicopters. Avoid any surgery if at all possible. If you've tried everything else, or it's an emergency, then surgery might be for you. If you go to a neurosurgeon, they are likely much more comfortable with recommending surgery, but consider that 2/3 of their back surgeries require further work to reduce the problem, AND they get an average of $20,000 in revenue for each discectomy procedure.

What works for me are various stretches, core exercises, getting at least 10,000 steps a day, and physical therapy if the sciatica flares up.

[Dash man]

I’ve been seeing a pain management specialist for 15 years. The ablations are the best treatment I’m aware of. I sometimes get a nerve block between them. Medicare only allows one ablation per year per location. My previous insurance allowed two.

[npage]

Quote:

Originally Posted by Dash man I’ve been seeing a pain management specialist for 15 years. The ablations are the best treatment I’m aware of. I sometimes get a nerve block between them. Medicare only allows one ablation per year per location. My previous insurance allowed two.

Interesting my Dad's doctor gets two approved for him on Medicare a year. I am on excellent corporate coverage right now of DW and can only get one approved a year. Last year tried to get one Epidural approved in between and they denied it under the guise I already had "one intervention" that year.

Seems so inconsistent year to year and I think different doctors and staff are better at fighting it than others based on size of practice, effort and probably other factors.

[bhoferp]

Thanks to all of you who took the time to respond. I am always impressed by how many nice people are on this forum.

[Dash man]

Quote:

Originally Posted by npage Interesting my Dad's doctor gets two approved for him on Medicare a year. I am on excellent corporate coverage right now of DW and can only get one approved a year. Last year tried to get one Epidural approved in between and they denied it under the guise I already had "one intervention" that year.

I get four ablations per year, one each in four different locations.

[big-papa]

Interesting. About the 33% as I'd never heard that before.
1. Started with pain management, which began with an MRI which showed a bulging disc
2. Then that moved to physical therapy for a month - no effect
3. That moved to injection #1, no effect
4. Then more PT, then no effect
5. Then injection #2, no effect
6. Switching to Neurosurgeon and more PT and no effect. By now I had the world's strongest back - that still hurt.
7. Finally, partial lumbar discectomy as an outpatient
8. Some recovery time, then some PT to get my strength back.

This was in about 2007 or so. Since then, nearly pain free unless I do something stupid. Even then, it's an order of magnitude less than before the surgery. I'd call it a success but your mileage may definitely vary!

[JoeWras]

Interesting big papa. My doc made me move heaven and earth before ordering an MRI. This was based on his experience with insurance, I think.

[Koolau]

Quote:

Originally Posted by bhoferp I have had pain in my lower left leg since before Thanksgiving. I have done physical therapy (including dry needling), tried prednisone and muscle relaxers, as well as hydrodone, an inversion table, an MRI and had my second steroid injection yesterday. My pain doctor says I have spinal stenosis, arthritis of the spine, and a bulging disk. If this spinal injection doesn't work, he is suggesting MILD. Have you had this procedure or know anyone who has and with what results? I have managed to get my pain level from 9 down to a 4 out of 10, but feel pretty ragged by the end of the day. I will be 74 in a few days and am otherwise in excellent health and don't take any prescriptions on a daily basis. Would you do the MILD procedure if you were in my position?

I'm blessed not to have leg pain, but it sounds like my MRI could be yours. So far, I've had two steroid shots at L4/L5. It helps some, but once in a while I get an unexpected clinching pain (pretty much off the chart in terms of pain.) I've been able to move just enough to alleviate the acute pain which then becomes a 3 or 4 for several minutes.

Doc has "mentioned" ablation, but I haven't explored it as I'm hoping for more permanent relief from the shots. So hoping you find something that works. Back pain can be debilitating and isolating. Worst for me, I've lost so much of my stamina and leg strength through inability to walk very much. YMMV

[harllee]

I suggested this above but I want to mention again TENS machine. They have done wonders for my back pain (and pain in other parts of the body). I bought a nice rechargeable one for under $50 on Amazon. At first TENS alleviated pain only when I was wearing it (there have been times when I wore it most of the day). After a while the pain relief became more permanent and now I only wear it occasionally. I highly recommend.

[JoeWras]

One interesting thing I learned about our spinal cord is it moves along the entire column! It helped explain why tilting my head forward gave me shooting pains in my calf.

One overlooked exercise technique is called flossing the nerve. It gets your spinal cord gently moving along the length of your spine to avoid it freezing. Like many other exercises in life, movement is better than no movement. You can look it up to get exercise ideas. The one I liked was sitting in a chair and doing an extended leg lift, while also bending your neck.

[big-papa]

Quote:

Originally Posted by JoeWras Interesting big papa. My doc made me move heaven and earth before ordering an MRI. This was based on his experience with insurance, I think.

Very possible! The thing is, I've had back pain off and on my whole life. Previously, it was pretty obvious to me when it was some sort of muscle strain related pain vs. this which, to me, was clearly foundational in nature. And this didn't come on suddenly, either, but it got to the point where it was finally time to do something. Glad the first person I went to ordered the MRI and even happier that the insurance company didn't have an issue with it.

Cheers.

[folivier]

I've been having NA's for a few years now with good success. This last one my pain doc was able to get both sides approved in one procedure and actually did a third location (said it was gratis if not covered by insurance). Also said that he could do the same twice each year. Something recently changed with medicare and allows this.
Are you guys having the NA's and injections done with a local or under anesthesia? Mine are done with local at his office.