Case Study: Leading Physician Helps Male Patient (71) Reduce Pain and Improve Quality of Life with mild^®

mild^® Provider, Dr. Mark Coleman | ABA Certified Pain Medicine Specialist | National Spine & Pain Centers

This case study highlights a male patient, age 71, with severe back pain that prevented him from performing his duties as a bus driver, as well as taking trips to the market with his sister. He underwent failed interventions, including multiple epidural steroid injections (ESIs), and finally found relief with Dr. Coleman, a leading pain management specialist and President of Clinical Operations at National Spine & Pain Centers, when he performed the mild^® Procedure using the Streamlined Technique with a single midline incision.

Patient History: Pre-mild^®

The patient had moderate, chronic constipation but was otherwise healthy. His history showed symptomatic lumbar spinal stenosis for three years. Symptoms grew more severe in the six months leading up to mild^®. The patient failed four lifetime lumbar epidural steroid injections (LESIs) with other providers (two within the three months prior to mild^®). He had no previous surgical history.

Symptoms of Neurogenic Claudication

The patient presented with classic symptoms of neurogenic claudication, including back and buttock pain with an inability to stand for more than two or three minutes. He experienced limited mobility, with a walking tolerance of two minutes with a cane. His pain increased with ambulation and produced numbness and tingling going down into the hamstrings. The pain was so severe, the patient had been unable to work as a bus driver in the previous six months.

The patient set goals of:

• Walking
• Returning to work
• Performing activities of daily living (e.g., grocery shopping)

MRI Findings

An MRI was performed, which found multiple levels of stenosis and several spinal comorbidities.

L2-3

• Hypertrophic ligamentum flavum resulting in severe [lumbar] spinal central stenosis
• Facet hypertrophy with right foraminal extrusion of the disc leading to moderate to severe right foraminal stenosis

L3-4

• Hypertrophic ligamentum flavum with moderate stenosis and degenerative facet arthropathy

L4-5

• Degenerative facet hypertrophy with hypertrophic ligamentum flavum resulting in moderate lumbar spinal stenosis
• Bilateral lateral foraminal stenosis

Procedure Details

Dr. Coleman treated three levels bilaterally using the Streamlined Technique, an efficient and predictable procedural method utilizing a single midline incision. Dr. Coleman used MAC sedation with a local anesthetic at an outpatient treatment center.

Upon discharge, the patient was instructed to resume normal activity within 24 hours with no restrictions.

The Results

After one week, the patient was able to walk for more than 20 minutes, up from less than three minutes before mild^®. The patient’s VAS went from 5/10 to 0/10 and he reported 100% pain relief. One day post procedure he was able to stand and ambulate without much pain.

“I haven’t had any problems since.”
“I took my sister to the market, I haven’t been able to do that!”

Watch the patient tell his results in his own words.

Video courtesy of National Spine & Pain Centers.

Key Takeaways

“The patient had multiple spinal comorbidities contributing to his moderate/severe stenosis including facet hypertrophy, foraminal stenosis and hypertrophic ligamentum flavum. I was able to treat the HLF (hypertrophic ligamentum flavum) bilaterally through a single midline incision with efficient access to all three stenosed levels. Decompression of just the HLF provided significant relief for the patient–resulting both in pain and functional improvement.”

“This patient is a perfect example of how imperative it is to move on from ESIs when they are no longer effective. … With the equivalent safety profile of an ESI,¹ mild^® is the logical next step.”