MILD Procedure
Do your legs ache, burn or feel heavy after only a few minutes of standing or walking, then ease when you sit or lean on a shopping cart? That pattern often points to lumbar spinal stenosis, a narrowing of the canal that houses the nerves in your lower back. At MVM Health, our pain specialists offer the MILD® procedure, a minimally invasive way to make more room for those nerves. It is done through an opening about the size of a baby aspirin, uses no implants and no general anesthesia, and most patients go home the same day.
Meet with a spine and pain specialist at one of our clinics in Pennsylvania, New Jersey, Ohio and Arizona to find out if MILD is right for you.
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Meet Our Expert Team
Board Certified Expert
At MVM Health — Movement. Vitality. Medicine. — we are committed to providing exceptional pain, vein, and wellness services that empower individuals to reclaim their health and well-being. With our team of Harvard-trained experts, we strive to deliver transformative outcomes that restore comfort, confidence, and quality of life. MVM Health’s mission is to help every patient relieve discomfort, restore motion, and renew life.
Vwaire Orhurhu, MD, MPH
Harvard Medical School
Mariam Salisu, MD, MPH
Harvard Medical School
Peter Isaac, DO
Philadelphia College of Osteopathic Medicine
Ali Amin, MD
Baylor College of Medicine
THOMAS KHOURY, MD
Harvard Medical School
ANTHONY TURNER, MD
Yale School of Medicine
KIRAN C. TAMIRISA
Baylor College of Medicine
TARIQ ALFARRA, DO
JOHNS HOPKINS HOSPITAL
Rishi Sheth, MD
University of Miami School of Medicine
Henry Onyeaka, MD, MPH
Harvard Medical School
Felicia Todd, CNP
Moravian College
Carrie Ward, CNP
Franklin University
Kruti Solanki, CNP
Drexel University
Christy Daniels, CNP
Chamberlain University
Heerina Kittel, CNP
Maryville University
Vic Urbano, CNP
Walden University
Jameela Azeem, CNP
Hofstra University
Vwaire Orhurhu, MD, MPH
Harvard Medical School
Mariam Salisu, MD, MPH
Harvard Medical School
Peter Isaac, DO
Philadelphia College of Osteopathic Medicine
Ali Amin, MD
Baylor College of Medicine
THOMAS KHOURY, MD
Harvard Medical School
ANTHONY TURNER, MD
Yale School of Medicine
KIRAN C. TAMIRISA
Baylor College of Medicine
Rishi Seth, MD
University of Miami School of Medicine
Henry Onyeaka, MD, MPH
Harvard Medical School
Felicia Todd, CNP
Moravian College
Vic Urbano, CNP
Walden University
Jameela Azeem, CNP
Hofstra University
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What Is the MILD Procedure?
MILD stands for Minimally Invasive Lumbar Decompression. It is an FDA-cleared, image-guided procedure for people whose lumbar spinal stenosis is caused, at least in part, by a thickened ligament at the back of the spinal canal.
That ligament is called the ligamentum flavum. Over the years it can stiffen and grow thicker, much like a callus. As it does, it bulges into the spinal canal and squeezes the nerves that travel to your hips, buttocks and legs. This is the main reason many people with stenosis can only stand or walk for a short time before pain, numbness or heaviness sets in.
During MILD, your physician uses small, specialized instruments to remove tiny pieces of that excess ligament, and sometimes a sliver of bone, from the back of the canal. This restores space for the nerves without cutting muscle, removing a whole disc or placing screws, rods or spacers. Because the supporting structures of the spine stay in place, it does not change how your spine is held together.
MILD is often considered for people with spinal stenosis whose pain has not improved enough with physical therapy or epidural injections, and who want an option before, or instead of, open spine surgery. Unlike an injection, which calms inflammation for a period of time, MILD addresses one of the physical causes of the narrowing.
What Happens During the MILD Procedure?
MILD is an outpatient procedure that usually takes less than an hour. Here is what to expect from arrival to going home.
Getting comfortable
You lie face down on a padded table. The skin over your lower back is cleaned and numbed with local anesthetic, and you may receive light sedation to help you relax. You do not need general anesthesia or a breathing tube.
Mapping the narrowed area
Using live X-ray (fluoroscopy) and a small amount of contrast dye, your physician outlines the spinal canal and pinpoints the levels where the ligament is pressing on the nerves. This matches what was seen on your MRI or CT scan.
Removing the excess tissue
Through a single opening about 5 millimeters wide, slim instruments are guided to the back of the canal. Tiny pieces of thickened ligament and bone are removed bit by bit, creating more room for the nerves. One or both sides, and more than one level, can be treated through the same small opening.
Closing and going home
The instruments are removed and the opening is covered with a small adhesive bandage, with no stitches needed. You rest in recovery for a short time while our team checks how you feel and walk. Most patients go home the same day with a friend or family member driving.
Common Conditions MILD Treats
Lumbar spinal stenosis
A narrowed canal in the lower back that crowds the nerves and limits how long you can stand or walk. See our page on spinal stenosis.
Ligamentum flavum hypertrophy
Thickening and stiffening of the ligament behind the spinal canal. This is the specific cause MILD is designed to treat.
Neurogenic claudication
Leg pain, cramping, heaviness or weakness that comes on with standing or walking and eases when you sit or bend forward.
Stenosis-related sciatica
Pain, tingling or numbness that travels into the buttock and down one or both legs because of nerve crowding. See our page on sciatica.
Degenerative spine changes
Age-related wear in the discs and joints that adds to canal narrowing. See our page on degenerative disc disease.
Spondylosis with stenosis
Arthritis of the spine, including bone spurs and enlarged joints, that contributes to a tighter canal. See our page on spondylosis.
Stenosis after limited relief from injections
For patients whose epidural injections helped only briefly, MILD offers a longer-lasting way to address the narrowing.
Stenosis in older
People who are not good candidates for open surgery or general anesthesia because of age, heart or lung conditions, or other health concerns.
Risk Factors
Lumbar spinal stenosis develops slowly, and your chances of having it rise if you:
- Are over age 50, when the spinal ligaments and joints tend to thicken
- Have arthritis in the spine, including bone spurs or enlarged facet joints
- Were born with a naturally narrow spinal canal
- Have had a past lower-back injury, fracture or spine surgery
- Carry extra body weight, which adds daily load to the lower spine
- Have spent years in heavy physical work or repeated bending and lifting
- Have a condition such as spondylolisthesis or scoliosis that changes spinal alignment
Symptoms
Stenosis symptoms often build over months or years. Common signs include:
- Leg or buttock pain, heaviness or cramping that starts after standing or walking a short distance
- Relief when you sit down, bend forward or lean on a cart or walker
- Numbness, tingling or a "pins-and-needles" feeling in the legs or feet
- Legs that feel weak, tired or unsteady, especially on longer walks
- Lower back ache that worsens when you stand straight or arch backward
- Needing to stop and rest during errands, shopping or household tasks
- Walking less, or avoiding outings, because you fear the pain will start
When Pain Needs Urgent Care
Stenosis usually worsens gradually and is not an emergency. MILD is a planned procedure and is not the right step if you have any of these warning signs. Get urgent medical care if your back or leg pain comes with:
- New loss of bladder or bowel control, or trouble passing urine
- Numbness in the groin, genitals, buttocks or inner thighs (“saddle” numbness)
- Leg weakness that is quickly getting worse, or a foot that drags
- Fever, chills or night sweats along with back pain
- Sudden, severe back pain after a fall or injury, especially if you have osteoporosis
- A history of cancer with new back pain, or unexplained weight loss
- Chest pain or trouble breathing (call 911)
These symptoms can signal severe nerve compression, infection, a fracture or another serious condition that needs prompt care.
Book a pain evaluation
Other Treatment Options
Stenosis care is a step-by-step path. We start with the gentlest options that fit your symptoms and move forward only if you need more relief. MILD sits between injections and open surgery, and many people never need surgery at all.
Conservative care
Epidural steroid injections
Anti-inflammatory medicine is placed near irritated spinal nerves to ease pain that radiates into an arm or leg, such as from a herniated disc or stenosis.
Facet joint injections and nerve blocks
Medicine is placed in or near the small joints of the spine to ease arthritis pain. A positive response also helps confirm where the pain starts.
Radiofrequency ablation (RFA)
Controlled heat quiets the small nerves that carry pain signals from arthritic spine joints. It’s often considered after a successful nerve block.
Spinal cord stimulation
A small device sends mild electrical pulses that change how pain signals reach the brain. It’s used for long-term pain that hasn’t responded to other care, and it starts with a short trial.
PRP and regenerative medicine
Platelets from your own blood may support healing in some joint and soft-tissue conditions. Your provider will tell you whether it’s a reasonable option for you.
Getting the Most From Your MILD Procedure
The procedure opens up space for your nerves. What you do in the weeks afterward helps you turn that space into more walking, standing and everyday activity.
Callout: Call our office if you notice fever, increasing redness, swelling or drainage at the bandage site, or new leg weakness or numbness.
Keep the site clean and dry. Leave the bandage on as instructed and avoid baths, pools or hot tubs until your provider says it is safe.
Walk early and often. Short, easy walks on the day of the procedure and the days after support healing better than lying in bed.
Skip heavy lifting for a while. Avoid lifting, bending or twisting hard for about one to two weeks, or for the time your provider recommends.
Use ice for mild soreness. Some tenderness around the site is normal for a few days. A cold pack for 15 to 20 minutes at a time can help.
Build strength with physical therapy. A guided exercise program can improve your walking distance, posture and balance as the nerves recover.
Frequently Asked Questions
Adults with lumbar spinal stenosis whose leg or back pain worsens with standing or walking, and whose imaging shows a thickened ligamentum flavum. Most candidates have already tried therapy, medication or injections without lasting relief.
It is a minimally invasive procedure, not open surgery. There is no large incision, no muscle cutting, no general anesthesia and nothing left inside your body.
You receive local numbing medicine and usually light sedation, so you stay relaxed and comfortable. Most patients feel pressure rather than pain.
The procedure itself usually takes under an hour. Plan for a few hours at the facility, including preparation and a short recovery period.
Most people walk the same day and return to light daily activities within a day or two. Heavy lifting and strenuous exercise usually wait about one to two weeks.
Some patients can stand or walk longer within days. For others, improvement builds over several weeks as irritated nerves settle.
Often, yes. Your specialist will review your surgical history and recent imaging to see whether the ligament can still be treated safely.
Medicare covers MILD for patients who meet its criteria, and many commercial plans do as well. Some require prior authorization. Our team verifies your benefits and expected costs before scheduling.
Serious complications are uncommon. As with any spine procedure, risks include soreness, bleeding, infection, a spinal fluid leak or nerve irritation. Your physician will review these with you in detail.
No. Because no implants are placed and the spine’s structure is preserved, other options such as injections, spinal cord stimulation or surgery remain available if you need them.
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