title: Report from a quality assurance program on patients undergoing the MILD procedure.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Retrospective observational cohort study.
  
  
  METHODS
  Academic multidisciplinary pain center at Stony Brook Medicine.
  
  
  METHODS
  Patients undergoing the MILD procedure from October 2010 to November 2012.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Anesthesiology, Stony Brook University, Stony Brook, New York, USA. brian.durkin@stonybrookmedicine.edu
authors.forename: Brian
authors.initials: B
authors.lastname: Durkin
authors.forename: Jamie
authors.initials: J
authors.lastname: Romeiser
authors.forename: A Laurie W
authors.initials: AL
authors.lastname: Shroyer
authors.forename: Robin
authors.initials: R
authors.lastname: Schiller
authors.forename: Jin
authors.initials: J
authors.lastname: Bae
authors.forename: Raphael P
authors.initials: RP
authors.lastname: Davis
authors.forename: Robert
authors.initials: R
authors.lastname: Peyster
authors.forename: Helene
authors.initials: H
authors.lastname: Benveniste
mesh_terms: D000368:Aged; D015897:Comorbidity; D003362:Cost-Benefit Analysis; D019299:Decompression, Surgical / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D017116:Low Back Pain / Q000453:epidemiology* / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery; D019060:Minimally Invasive Surgical Procedures / Q000592:standards* / Q000706:statistics & numerical data; D009518:New York / Q000453:epidemiology; D059408:Pain Management / Q000592:standards; D015995:Prevalence; D011446:Prospective Studies; D011785:Quality Assurance, Health Care / Q000592:standards / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018570:Risk Assessment; D013130:Spinal Stenosis / Q000453:epidemiology* / Q000601:surgery*; D016896:Treatment Outcome