• Pain Med · May 2013

    Observational Study

    Report from a quality assurance program on patients undergoing the MILD procedure.

    • Brian Durkin, Jamie Romeiser, A Laurie W Shroyer, Robin Schiller, Jin Bae, Raphael P Davis, Robert Peyster, and Helene Benveniste.
    • Department of Anesthesiology, Stony Brook University, Stony Brook, New York, USA. brian.durkin@stonybrookmedicine.edu
    • Pain Med. 2013 May 1;14(5):650-6.

    ObjectivesTo characterize trends in pain and functional outcomes and identify risk factors in patients with lumbar spinal stenosis (LSS) and neurogenic claudication undergoing the "Minimally Invasive Lumbar Decompression" (MILD) procedure.DesignRetrospective observational cohort study.SettingAcademic multidisciplinary pain center at Stony Brook Medicine.SubjectsPatients undergoing the MILD procedure from October 2010 to November 2012.MethodsDe-identified perioperative, pain and function related data for 50 patients undergoing MILD were extracted from the Center for Pain Management's quality assessment database. Data included numerical rating scale (NRS), symptom severity and physical function (Zurich Claudication Questionnaire), functional status (Oswestry Disability Index [ODI]), pain interference scores (National Institutes of Health Patient-Reported Outcomes Measurement Information System [PROMIS]), and patients' self-reported low back and lower extremity pain distribution.ResultsNo 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.ConclusionOverall, 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.Wiley Periodicals, Inc.

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