In brief
- MILD removes small pieces of excess ligament and bone to unclog the spinal canal, so you can walk farther and stand longer.
- No stitches, no general anesthesia, and no hardware left behind.
- Resume light indoor activity immediately; most patients resume regular activities within a day. Keep lifting under 15 pounds for 7 days.
- Many patients notice improved standing and walking distance within days as the nerves recover.
Understanding your diagnosis
Lumbar spinal stenosis occurs when the spinal canal narrows, often due to a thickened ligament (ligamentum flavum). This puts pressure on the nerves in your lower back, causing pain, heaviness, or numbness in your legs that worsens when standing or walking, a condition known as neurogenic claudication.
The treatment
MILD is a safe, minimally invasive procedure designed to restore space in the spinal canal. Without the need for general anesthesia or stitches, Dr. Pugh uses specialized tools to remove small pieces of excess ligament and bone through a tiny incision. By unclogging the canal, we address the root cause of your pain and help you walk farther and stand longer.
Our approach
Our independent practice offers evidence-based alternatives to invasive spine surgery. Using live X-ray (fluoroscopy), Dr. Pugh ensures maximum precision and safety. The procedure has a safety profile similar to an epidural injection but provides lasting functional results.
Before your procedure
For your safety, certain medications must be held before your procedure to minimize the risk of bleeding, following American Society of Regional Anesthesia guidelines. This procedure requires the 24-hour NSAID hold.
| Medication type | Examples | Required hold |
|---|---|---|
| NSAIDs | Ibuprofen, Motrin, Aleve, naproxen, meloxicam | 24 hours |
| Salicylates | Aspirin, all doses | 24 hours |
| Antiplatelets | Plavix (clopidogrel), Brilinta | 7 days |
| Antiplatelets | Effient (prasugrel) | 10 days |
| Anticoagulants | Eliquis, Xarelto, Savaysa, Pradaxa | 5 days |
| Vitamin K antagonist | Coumadin, warfarin | 5 days (INR below 1.5) |
Restarting
Most medications can be restarted 24 hours after the procedure. NSAIDs and aspirin may be resumed immediately.
Fasting, sedation, and your ride home
- If you are receiving sedation, nothing to eat or drink for six hours before your appointment. Essential morning medications may be taken with a small sip of water only.
- We offer light or deep sedation. The level is decided by the physician and anesthesia team based on the procedure and clinical need.
- Any patient receiving sedation must be accompanied by a responsible adult driver to take them home.
Where to go
Procedures are performed at one of three facilities: our clinic at 1925 Hospital Place, ACOM at 6449 Central Park Blvd, or Hendrick South at 6399 Directors Pkwy, Suite 100. Your appointment paperwork tells you which one. Please arrive early for registration and pre-procedure preparation.
Procedure day
- Performed under live X-ray for continuous safety monitoring.
- Local numbing and light sedation are used for your comfort.
- The procedure typically takes less than an hour.
- This is an outpatient procedure; you will go home the same day.
Benefits
- Lasting relief: significant long-term improvement in standing and walking distance.
- Minimally invasive: no stitches, no general anesthesia, and no hardware left behind.
- Rapid recovery: most patients return to light activity within 24 hours.
Recovery
- Activity: resume light, indoor activity immediately; most patients resume regular activities within a day.
- Wound care: the incision is closed with a simple adhesive bandage; keep the area clean and dry for 2 days.
- Follow-up: a visit will be scheduled in 7 to 10 days to monitor your progress.
Afterward: what to expect
- The relief. Many patients notice an improvement in standing and walking distance within days as the spinal nerves recover.
- Site soreness. You may feel mild localized soreness or a bruised sensation around the tiny incision for 2 to 5 days.
- Management. Use ice packs (20 minutes on, 20 off) for localized soreness and resume baseline medications. You may resume NSAIDs and aspirin immediately after the procedure.
Activity
Wound care
Your procedure in one paragraph
You have undergone a MILD (minimally invasive lumbar decompression) procedure, a specialized treatment designed to address neurogenic claudication caused by lumbar spinal stenosis. Through a tiny incision, we have removed small pieces of excess ligament and bone to unclog your spinal canal and relieve pressure on your lower back nerves. This procedure was performed to help you walk farther and stand longer without the heavy, aching leg discomfort.
Follow-up schedule
- 1
7 to 14 days
Wound check and post-operative review.
- 2
3 months
Formal functional assessment of how well the procedure worked.
Call us right away if you notice
- New or worsening leg weakness, numbness, or foot drop
- Sudden loss of bowel or bladder control
- Fever above 101.5°F, chills, or drainage at the site
- A severe headache that worsens when sitting or standing
This guide is the same information as the printed handout from Abilene Pain. It is general information and does not replace the instructions your care team gives you at your visit. Your care team: Nicolas Pugh, MD · Adrianne Anders, NP · Ted Chaka, PA.