Long-Term Safety and Efficacy of Minimally Invasive Lumbar Decompression Procedure for the Treatment of Lumbar Spinal Stenosis With Neurogenic Claudication: 2-Year Results of MiDAS ENCORE

• Published in: Regional anesthesia and pain medicine Vol. 43; no. 7; pp. 1 - 794
• Main Authors: Staats, Peter S., Chafin, Timothy B., Golovac, Stanley, Kim, Christopher K., Li, Sean, Richardson, William B., Vallejo, Ricardo, Wahezi, Sayed E., Washabaugh, Edward P., Benyamin, Ramsin M.
• Format: Journal Article
• Language: English
• Published: England Copyright by American Society of Regional Anesthesia and Pain Medicine 01.10.2018; Lippincott Williams & Wilkins
• Subjects: Aged; Aged, 80 and over; Chronic and Interventional Pain: Original; Decompression, Surgical - methods; Decompression, Surgical - trends; Female; Follow-Up Studies; Humans; Ligamentum Flavum - diagnostic imaging; Ligamentum Flavum - surgery; Lumbar Vertebrae - diagnostic imaging; Lumbar Vertebrae - surgery; Male; Minimally Invasive Surgical Procedures - methods; Minimally Invasive Surgical Procedures - trends; Spinal Stenosis - diagnostic imaging; Spinal Stenosis - surgery; Time Factors; Treatment Outcome
• ISSN: 1098-7339; 1532-8651; 1532-8651
• DOI: 10.1097/AAP.0000000000000868

BACKGROUND AND OBJECTIVESThis study evaluated the long-term durability of the minimally invasive lumbar decompression (MILD) procedure in terms of functional improvement and pain reduction for patients with lumbar spinal stenosis and neurogenic claudication due to hypertrophic ligamentum flavum. This is a report of 2-year follow-up for MILD study patients. METHODSThis prospective, multicenter, randomized controlled clinical study compared outcomes for 143 patients treated with MILD versus 131 treated with epidural steroid injections. Follow-up occurred at 6 months and at 1 year for the randomized phase and at 2 years for MILD subjects only. Oswestry Disability Index, Numeric Pain Rating Scale, and Zurich Claudication Questionnaire were used to evaluate function and pain. Safety was evaluated by assessing incidence of device-/procedure-related adverse events. RESULTSAll outcome measures demonstrated clinically meaningful and statistically significant improvement from baseline through 6-month, 1-year, and 2-year follow-ups. At 2 years, Oswestry Disability Index improved by 22.7 points, Numeric Pain Rating Scale improved by 3.6 points, and Zurich Claudication Questionnaire symptom severity and physical function domains improved by 1.0 and 0.8 points, respectively. There were no serious device-/procedure-related adverse events, and 1.3% experienced a device-/procedure-related adverse event. CONCLUSIONSMILD showed excellent long-term durability, and there was no evidence of spinal instability through 2-year follow-up. Reoperation and spinal fracture rates are lower, and safety is higher for MILD versus other lumbar spine interventions, including interspinous spacers, surgical decompression, and spinal fusion. Given the minimally invasive nature of this procedure, its robust success rate, and durability of outcomes, MILD is an excellent choice for first-line therapy for select patients with central spinal stenosis suffering from neurogenic claudication symptoms with hypertrophic ligamentum flavum. CLINICAL TRIAL REGISTRATIONThis study was registered at ClinicalTrials.gov, identifier NCT02093520.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.