Report From a Quality Assurance Program on Patients Undergoing the MILD Procedure. Issue 5 (14th March 2013)

• Record Type: Journal Article
• Authors: Durkin, Brian; Romeiser, Jamie; Shroyer, A. Laurie W.; Schiller, Robin; Bae, Jin; Davis, Raphael P.; Peyster, Robert; Benveniste, Helene
• Is Part Of: Pain medicine. Volume 14:Issue 5(2013)
• Page Start: 650
• Page End: 656
• Publication Date: 2013-03-14
• Subjects: Pain -- Periodicals; Pain -- Treatment -- Periodicals; Analgesics -- Periodicals; Pain -- Periodicals; Pain Management -- Periodicals; Douleur -- Périodiques; Douleur -- Traitement -- Périodiques; Analgésiques -- Périodiques; Analgésique; Soulagement de la douleur; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); 616.047205
• DOI: 10.1111/pme.12079
• Languages: English
• ISSNs: 1526-2375

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="pme12079-sec-0001" sec-type="section"> <title>Objectives.</title> <p>To 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.</p> </sec> <sec id="pme12079-sec-0002" sec-type="section"> <title>Design.</title> <p>Retrospective observational cohort study.</p> </sec> <sec id="pme12079-sec-0003" sec-type="section"> <title>Setting.</title> <p>Academic multidisciplinary pain center at Stony Brook Medicine.</p> </sec> <sec id="pme12079-sec-0004" sec-type="section"> <title>Subjects.</title> <p>Patients undergoing the MILD procedure from October 2010 to November 2012.</p> </sec> <sec id="pme12079-sec-0005" sec-type="section"> <title>Methods.</title> <p>De‐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.</p> </sec> <sec id="pme12079-sec-0006" sec-type="section"> <title>Results.</title> <p>No 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.</p> </sec> <sec id="pme12079-sec-0007" sec-type="section"> <title>Conclusion.</title> <p>Overall, 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.</p> </sec> </abstract>