Minimally Invasive Lumbar Decompression (MILD) in Patients with Lumbar Spinal Stenosis: A Systematic Review of Randomized and Prospective Trials.

Abstract

Background/importance: Lumbar spinal stenosis (LSS) remains one of the most common causes of pain and functional disability in patients with chronic pain. Minimally invasive lumbar decompression (MILD) has been shown to reduce pain and improve function with lumbar spinal stenosis. However, very few large studies have evaluated the short- and long-term effects of MILD on functional improvement and pain reduction.

Purpose: To evaluate the evidence on the MILD procedure for chronic pain patients with LSS.

Methods: A systematic review of randomized and prospective trials investigating the effectiveness of the MILD procedure in managing low back pain and lower extremity pain was performed using PubMed, Medline, Embase, Google Scholar, clinical trial.gov, and Cochrane. We utilized the Cochrane review methodologic quality assessment, GRADE and Interventional Pain Management Techniques - Quality Appraisal of Reliability and Risk of Bias Assessment (IPM-QRB) and IPM-QRB for Nonrandomized Studies (IPM-QRBNR) to guide our data extraction and assessment of study quality methods. Our study summarized and presented the evidence quality on a scale of 1 to 5.

Results: Fifteen MILD studies met our inclusion criteria. There were 8 studies that were multicenter prospective trials, and 7 studies were single centers prospective trials. The evidence based on a systematic review of prospective trials investigating the efficacy of the MILD procedure showed a median level 2b evidence with several level 1b studies available. Pain and functional outcome GRADE assessment of studies was high quality.

Conclusion: This systematic review suggests that the MILD procedure can be effective in managing chronic pain patients with lumbar spinal stenosis.