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The Impact of Age on the Outcomes of Minimally Invasive Lumbar Decompression for Lumbar Spinal Stenosis

Authors Mekhail NA, Costandi SJ, Armanyous S, Vallejo R, Poree LR, Brown LL, Golovac S, Deer TR

Received 27 February 2020

Accepted for publication 15 May 2020

Published 4 June 2020 Volume 2020:13 Pages 151—161


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

Nagy A Mekhail,1 Shrif J Costandi,1 Sherif Armanyous,1 Ricardo Vallejo,2 Lawrence R Poree,3 Lora L Brown,4 Stanley Golovac,5 Timothy R Deer6

1Evidence-Based Pain Management Research, Cleveland Clinic, Cleveland, OH, USA; 2Millennium Pain Center, Bloomington, IL, USA; 3Pain Management Center, UCSF Health, San Francisco, CA, USA; 4TruWell Health, St. Petersburg, FL, USA; 5Florida Pain Institute, Merritt Island, FL, USA; 6Center for Pain Relief, Charleston, WV, USA

Correspondence: Nagy A Mekhail Email

Background and Purpose: Minimally invasive lumbar decompression (mild®) is an effective long-term therapy for patients with symptomatic lumbar spinal stenosis (LSS) resulting primarily from hypertrophic ligamentum flavum (HLF). Most subjects in clinical studies of the mild procedure have been older adults (age≥ 65). While the incidence of LSS increases with age, a substantial number of adults (age< 65) also suffer from neurogenic claudication secondary to HLF. In this report, outcomes of mild were compared between adults and older adults.
Patients and Methods: All prospective studies of the mild procedure with a 1-year follow-up completed since the beginning of 2012 that allowed the inclusion of adult patients of all ages were reviewed. Outcomes of visual analog scale (VAS), Oswestry Disability Index (ODI), Pain Disability Index (PDI), Roland Morris Low Back Pain and Disability Questionnaire (RMQ), standing time and walking distance were compared for adults and older adults.
Results: Four studies met the inclusion criteria, resulting in an analysis of 49 adults and 160 older adults. Patients in both age groups experienced significant mean improvements in all but one outcome measure at 6- and 12-month follow-up. Differences between the two age groups in all scores at 6 and 12 months were not statistically significant.
Conclusion: Analysis of the four studies indicated that symptom improvements for adults and older adults were significant from baseline, and no statistically significant difference was observed between the two age groups. These results illustrate that mild can be an effective treatment for LSS due primarily to HLF, regardless of the adult patient age.

Keywords: mild, neurogenic claudication, ligamentum flavum, LSS

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