New procedure brings relief to sufferers of lumbar spinal stenosis

PINEHURST – Retired nurse Anita Abatemarco found herself putting some of her old professional skills into use during her husband’s final illness last summer. But turning and lifting her beloved Rocco took a toll on her lower back, and it wasn’t long before the tiny 79-year-old was holding onto furniture to get around her Pinehurst home – especially in the morning when the pain was more severe.

Nothing, not even three epidural injections, seemed to help.

“I had absolutely no relief from the pain,” Abatemarco says.

A new treatment option provided by a pain specialist at FirstHealth’s Back & Neck Pain Center offers the chance for relief for people like Abatemarco who suffer from lumbar spinal stenosis (LSS). The MILD (Minimally Invasive Lumbar Decompression) procedure relieves the pain by removing a primary source of LSS pain, which is caused by narrowing in the spinal canal due to the growth of bone or tissue.

LSS is a common condition with more than 1.2 million patients diagnosed and treated each year. As the space in the spinal canal shrinks, increasing pressure is placed on the nerves that go through it to the legs, causing pain, numbness or weakness in the lower back, buttocks, legs and feet.

The physical discomfort tends to worsen while the patient is walking or standing, and is relieved by bending forward, sitting or lying down. Patients commonly complain of difficulty walking even short distances, and do so with a characteristic stooped posture in more advanced cases.

Paul Kuzma, M.D., of Pinehurst Anesthesia Associates, is one of only a handful of North Carolina physicians who have been trained in the MILD procedure, which has been proven safe and effective in several clinical studies. Two other anesthesiologists with Pinehurst Anesthesia Associates are currently being trained.

Using X-ray guidance, the physician uses miniature instruments that are introduced through a needle about the size of a pencil to remove the small pieces of ligament and bone contributing to the spinal stenosis. As the bone and tissue are removed, the size of the spinal canal increases and the pressure on the nerves is relieved.

At completion, a bandage is applied to the back and the patient goes home.

Patients most likely to benefit from the treatment are usually in their 60s, 70s and 80s, and most have tried a variety of other therapies (physical therapy, acupuncture, chiropractics) or symptom management (medication, epidural steroid injections and pain pumps) without success.

“When I see patients, they’ve usually been through quite a lot by the time we get to this discussion,” Dr. Kuzma says. “Those who are most likely to benefit from this procedure are those who want to be active but are limited by back and leg pain or heaviness when they start to walk. We have a lot of people who have moved to Pinehurst so that they can have an active retirement. They don’t want to sit in a rocking chair. They want to play golf and tennis and be active. These are the patients that we really hope to help.”

A less invasive alternative to open or endoscopic surgery, the MILD procedure was developed to provide a safe therapeutic solution earlier in the LSS treatment process.

“The results have been really good,” Dr. Kuzma says. “We can’t address everything that causes spinal stenosis, but we can address some of it.”

Abatemarco, who was one of Dr. Kuzma’s first MILD patients, had been dealing with severe pain that began in her pelvis and radiated down her right leg and into her ankle. She was immediately interested when Dr. Kuzma first mentioned the procedure to her and is very pleased with the results.

“When you have that pain, you don’t want it to ever come back,” she says. “I’m grateful for this procedure. I really am.”

For more information on the “mild” procedure for lumbar spinal stenosis or the FirstHealth Back & Neck Pain Center, call (910) 715-1478 or (800) 213-3284 toll-free.