Comparative Clinical Efficacy and Long-Term Durability of Minimally Invasive Lumbar Decompression (MILD) in Patients with Ligamentum Flavum Hypertrophy

Authors

• Jessica Rulen-Riddle, University of LynchburgFollow

Specialty

Interventional Pain Management

Advisor

Dr. Herman Lawrence

Abstract

ABSTRACT

This manuscript evaluates the therapeutic benefit of the minimally invasive lumbar decompressive (MILD) procedure relative to the open lumbar decompressive surgery for patients with lumbar spinal stenosis (LSS) and neurogenic claudication. The methodology for this clinical review entailed a structured search of PubMed, Google Scholar, and ScienceDirect. Inclusion criteria were limited to peer-reviewed studies published between 2020 and 2025 that provided quantitative longitudinal outcomes. The most common cause of lumbar spinal surgery is hypertrophy of the ligamentum flavum, causing spinal stenosis, leading to symptoms of neurogenic claudication. It can lead to compression of spinal nerve roots, causing these symptoms and spasticity. This paper focuses on treating lumbar ligamentum hypertrophy as the primary cause of LSS. The outcomes of the MILD procedure depend on the clinical presentation of hypertrophy of the ligamentum flavum. This procedure offers an alternative to surgical intervention that is safe while allowing patients to achieve adequate pain control and improved recovery times. Multiple studies demonstrate that the MILD procedure delivers long-term clinical benefits, including pain relief and improvements in quality of life, for patients with symptoms limited to a few levels. The minimally invasive approaches have demonstrated greater pain relief and shorter recovery times. Longitudinal data reveal further that 88% of patients avoided spinal surgery at a 5-year follow-up.  Data indicate a statistically significant reduction of 40% Morphine Milligram Equivalent (MME) amount in MILD cohorts, supporting its role in opioid stewardship. MILD serves as a strategic clinical option for patients who are not candidates for surgical intervention. Ultimately, this review shows that the MILD procedure provides a safe and lasting benefit if performed on a stringent patient selection. By delaying or potentially obviating the need for a major spinal surgery, clinical outcomes are optimized through improved function, less narcotic pain medication use with decreased pain scores, and avoiding the high-risk complications common with major surgery. Instead of viewing it as a stopgap, clinicians should use MILD as a strategic framework to maintain patient mobility and dignity. Moving toward this more minimally invasive standard represents a substantial step toward a patient-centered, risk-conscious spinal care plan that is statistically significant.

Recommended Citation

Rulen-Riddle J. Comparative Clinical Efficacy and Long-Term Durability of Minimally Invasive Lumbar Decompression (MILD) in Patients with Ligamentum Flavum Hypertrophy. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2026; 8(1).