Long-Term Safety and Efficacy of Minimally Invasive Lumbar Decompression Procedure for the Treatment of Lumbar Spinal Stenosis with Neurogenic Claudication: 2-Year Results of MiDAS ENCORE

Peter S. Staats, Timothy B. Chafin, Stanley Golovac, Christopher K. Kim, Sean Li, William B. Richardson, Ricardo Vallejo, Sayed E. Wahezi, Edward P. Washabaugh, Ramsin M. Benyamin

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Abstract

Background and Objectives This study evaluated the long-term durability of the minimally invasive lumbar decompression (MILD) procedure in terms of functional improvement and pain reduction for patients with lumbar spinal stenosis and neurogenic claudication due to hypertrophic ligamentum flavum. This is a report of 2-year follow-up for MILD study patients. Methods This prospective, multicenter, randomized controlled clinical study compared outcomes for 143 patients treated with MILD versus 131 treated with epidural steroid injections. Follow-up occurred at 6 months and at 1 year for the randomized phase and at 2 years for MILD subjects only. Oswestry Disability Index, Numeric Pain Rating Scale, and Zurich Claudication Questionnaire were used to evaluate function and pain. Safety was evaluated by assessing incidence of device-/procedure-related adverse events. Results All outcome measures demonstrated clinically meaningful and statistically significant improvement from baseline through 6-month, 1-year, and 2-year follow-ups. At 2 years, Oswestry Disability Index improved by 22.7 points, Numeric Pain Rating Scale improved by 3.6 points, and Zurich Claudication Questionnaire symptom severity and physical function domains improved by 1.0 and 0.8 points, respectively. There were no serious device-/procedure-related adverse events, and 1.3% experienced a device-/procedure-related adverse event. Conclusions MILD showed excellent long-term durability, and there was no evidence of spinal instability through 2-year follow-up. Reoperation and spinal fracture rates are lower, and safety is higher for MILD versus other lumbar spine interventions, including interspinous spacers, surgical decompression, and spinal fusion. Given the minimally invasive nature of this procedure, its robust success rate, and durability of outcomes, MILD is an excellent choice for first-line therapy for select patients with central spinal stenosis suffering from neurogenic claudication symptoms with hypertrophic ligamentum flavum. Clinical Trial Registration This study was registered at ClinicalTrials.gov, identifier NCT02093520.

Original languageEnglish (US)
Pages (from-to)789-794
Number of pages6
JournalRegional Anesthesia and Pain Medicine
Volume43
Issue number7
DOIs
StatePublished - Oct 1 2018

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Spinal Stenosis
Decompression
Safety
Ligamentum Flavum
Pain
Equipment and Supplies
Therapeutics
Spinal Fractures
Epidural Injections
Surgical Decompression
Spinal Fusion
Reoperation
Spine
Steroids
Outcome Assessment (Health Care)
Clinical Trials
Incidence

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Long-Term Safety and Efficacy of Minimally Invasive Lumbar Decompression Procedure for the Treatment of Lumbar Spinal Stenosis with Neurogenic Claudication : 2-Year Results of MiDAS ENCORE. / Staats, Peter S.; Chafin, Timothy B.; Golovac, Stanley; Kim, Christopher K.; Li, Sean; Richardson, William B.; Vallejo, Ricardo; Wahezi, Sayed E.; Washabaugh, Edward P.; Benyamin, Ramsin M.

In: Regional Anesthesia and Pain Medicine, Vol. 43, No. 7, 01.10.2018, p. 789-794.

Research output: Contribution to journalArticle

Staats, Peter S. ; Chafin, Timothy B. ; Golovac, Stanley ; Kim, Christopher K. ; Li, Sean ; Richardson, William B. ; Vallejo, Ricardo ; Wahezi, Sayed E. ; Washabaugh, Edward P. ; Benyamin, Ramsin M. / Long-Term Safety and Efficacy of Minimally Invasive Lumbar Decompression Procedure for the Treatment of Lumbar Spinal Stenosis with Neurogenic Claudication : 2-Year Results of MiDAS ENCORE. In: Regional Anesthesia and Pain Medicine. 2018 ; Vol. 43, No. 7. pp. 789-794.
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abstract = "Background and Objectives This study evaluated the long-term durability of the minimally invasive lumbar decompression (MILD) procedure in terms of functional improvement and pain reduction for patients with lumbar spinal stenosis and neurogenic claudication due to hypertrophic ligamentum flavum. This is a report of 2-year follow-up for MILD study patients. Methods This prospective, multicenter, randomized controlled clinical study compared outcomes for 143 patients treated with MILD versus 131 treated with epidural steroid injections. Follow-up occurred at 6 months and at 1 year for the randomized phase and at 2 years for MILD subjects only. Oswestry Disability Index, Numeric Pain Rating Scale, and Zurich Claudication Questionnaire were used to evaluate function and pain. Safety was evaluated by assessing incidence of device-/procedure-related adverse events. Results All outcome measures demonstrated clinically meaningful and statistically significant improvement from baseline through 6-month, 1-year, and 2-year follow-ups. At 2 years, Oswestry Disability Index improved by 22.7 points, Numeric Pain Rating Scale improved by 3.6 points, and Zurich Claudication Questionnaire symptom severity and physical function domains improved by 1.0 and 0.8 points, respectively. There were no serious device-/procedure-related adverse events, and 1.3{\%} experienced a device-/procedure-related adverse event. Conclusions MILD showed excellent long-term durability, and there was no evidence of spinal instability through 2-year follow-up. Reoperation and spinal fracture rates are lower, and safety is higher for MILD versus other lumbar spine interventions, including interspinous spacers, surgical decompression, and spinal fusion. Given the minimally invasive nature of this procedure, its robust success rate, and durability of outcomes, MILD is an excellent choice for first-line therapy for select patients with central spinal stenosis suffering from neurogenic claudication symptoms with hypertrophic ligamentum flavum. Clinical Trial Registration This study was registered at ClinicalTrials.gov, identifier NCT02093520.",
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AU - Chafin, Timothy B.

AU - Golovac, Stanley

AU - Kim, Christopher K.

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AB - Background and Objectives This study evaluated the long-term durability of the minimally invasive lumbar decompression (MILD) procedure in terms of functional improvement and pain reduction for patients with lumbar spinal stenosis and neurogenic claudication due to hypertrophic ligamentum flavum. This is a report of 2-year follow-up for MILD study patients. Methods This prospective, multicenter, randomized controlled clinical study compared outcomes for 143 patients treated with MILD versus 131 treated with epidural steroid injections. Follow-up occurred at 6 months and at 1 year for the randomized phase and at 2 years for MILD subjects only. Oswestry Disability Index, Numeric Pain Rating Scale, and Zurich Claudication Questionnaire were used to evaluate function and pain. Safety was evaluated by assessing incidence of device-/procedure-related adverse events. Results All outcome measures demonstrated clinically meaningful and statistically significant improvement from baseline through 6-month, 1-year, and 2-year follow-ups. At 2 years, Oswestry Disability Index improved by 22.7 points, Numeric Pain Rating Scale improved by 3.6 points, and Zurich Claudication Questionnaire symptom severity and physical function domains improved by 1.0 and 0.8 points, respectively. There were no serious device-/procedure-related adverse events, and 1.3% experienced a device-/procedure-related adverse event. Conclusions MILD showed excellent long-term durability, and there was no evidence of spinal instability through 2-year follow-up. Reoperation and spinal fracture rates are lower, and safety is higher for MILD versus other lumbar spine interventions, including interspinous spacers, surgical decompression, and spinal fusion. Given the minimally invasive nature of this procedure, its robust success rate, and durability of outcomes, MILD is an excellent choice for first-line therapy for select patients with central spinal stenosis suffering from neurogenic claudication symptoms with hypertrophic ligamentum flavum. Clinical Trial Registration This study was registered at ClinicalTrials.gov, identifier NCT02093520.

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