Open AccessReport From a Quality Assurance Program on Patients Undergoing the MILD Procedure
Author(s) -
Durkin Brian,
Romeiser Jamie,
Shroyer A. Laurie W.,
Schiller Robin,
Bae Jin,
Davis Raphael P.,
Peyster Robert,
Benveniste Helene
Publication year - 2013
Publication title -
pain medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.893
H-Index - 97
eISSN - 1526-4637
pISSN - 1526-2375
DOI - 10.1111/pme.12079
Subject(s) - medicine , oswestry disability index , physical therapy , lumbar spinal stenosis , neurogenic claudication , claudication , perioperative , observational study , cohort , low back pain , spinal stenosis , quality of life (healthcare) , retrospective cohort study , lumbar , surgery , vascular disease , arterial disease , alternative medicine , nursing , pathology
Objectives. To characterize trends in pain and functional outcomes and identify risk factors in patients with lumbar spinal stenosis ( LSS ) and neurogenic claudication undergoing the “ M inimally I nvasive L umbar D ecompression” ( MILD ) procedure. Design. Retrospective observational cohort study. Setting. Academic multidisciplinary pain center at S tony B rook M edicine.Subjects. Patients undergoing the MILD procedure from O ctober 2010 to N ovember 2012. Methods. De‐identified perioperative, pain and function related data for 50 patients undergoing MILD were extracted from the C enter for P ain M anagement's quality assessment database. Data included numerical rating scale ( NRS ), symptom severity and physical function ( Z urich C laudication Q uestionnaire), functional status ( O swestry D isability I ndex [ ODI ]), pain interference scores ( N ational I nstitutes of H ealth P atient‐ R eported O utcomes M easurement I nformation S ystem [ PROMIS ]), and patients' self‐reported low back and lower extremity pain distribution. Results. N o MILD patient incurred procedure‐related complications. Average NRS scores decreased postoperatively and 64.3% of patients reported less pain at 3 months. Clinically meaningful functional ODI improvements of at least 20% from baseline were present in 25% of the patients at 6 months. Preliminary analysis of changes in PROMIS scores at 3 months revealed that pre‐ MILD “severe” lumbar canal stenosis may be associated with high risk of “no improvement.” No such impact was observed for NRS or ODI outcomes. Conclusion. Overall, pain is reduced and functional status improved in LSS patients following the MILD procedure at 3 and 6 months. Given the small sample size, it is not yet possible to identify patient subgroups at risk for “no improvement.” Continued follow‐up of longer‐term outcomes appears warranted to develop evidence‐based patient selection criteria.