{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T04:42:18Z","timestamp":1791520938113,"version":"4.3.4"},"reference-count":18,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2021,5,13]],"date-time":"2021-05-13T00:00:00Z","timestamp":1620864000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pain Practice"],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Minimally invasive lumbar decompression (\n                      <jats:italic>mild<\/jats:italic>\n                      <jats:sup>\u00ae<\/jats:sup>\n                      ) has been shown to be safe and effective for the treatment of lumbar spinal stenosis patients with hypertrophic ligamentum flavum as a contributing factor. This study examines the long\u2010term durability of the\n                      <jats:italic>mild<\/jats:italic>\n                      procedure through 5\u2010year follow\u2010up. Pain relief and opioid medications utilization during 12\u2010month follow\u2010up were also assessed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      All patients diagnosed with lumbar spinal stenosis secondary to ligamentum flavum hypertrophy who underwent\n                      <jats:italic>mild<\/jats:italic>\n                      from 2010 through 2015 at the Cleveland Clinic Department of Pain Management were included in this retrospective longitudinal observational cohort study. The primary outcome measure was the incidence of open lumbar decompression surgery at the same level(s) as the\n                      <jats:italic>mild<\/jats:italic>\n                      intervention during 5\u2010year follow\u2010up. Secondary outcome measures were the change in pain levels using the Numeric Rating Scale and opioid medications utilization using Morphine Milligram Equivalent dose per day from baseline to 3, 6, and 12\u00a0months post\u2010\n                      <jats:italic>mild<\/jats:italic>\n                      procedure. Postprocedural complications (minor or major) were also collected.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Seventy\u2010five patients received\n                      <jats:italic>mild<\/jats:italic>\n                      during the protocol\u2010defined time period and were included in the study. Only 9 out of 75 patients required lumbar surgical decompression during the 5\u2010year follow\u2010up period. Subjects experienced statistically significant pain relief and reduction of opioid medications utilization at 3, 6, and 12\u00a0months compared to baseline.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Based on our analysis, the\n                      <jats:italic>mild<\/jats:italic>\n                      procedure is durable over 5\u00a0years and may allow elderly patients with symptomatic lumbar spinal stenosis to avoid lumbar decompression surgery while providing significant symptomatic relief.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/papr.13020","type":"journal-article","created":{"date-parts":[[2021,5,4]],"date-time":"2021-05-04T07:11:57Z","timestamp":1620112317000},"page":"826-835","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["The durability of minimally invasive lumbar decompression procedure in patients with symptomatic lumbar spinal stenosis: Long\u2010term follow\u2010up"],"prefix":"10.1111","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3823-9610","authenticated-orcid":false,"given":"Nagy","family":"Mekhail","sequence":"first","affiliation":[{"name":"Evidence\u2010Based Pain Management Research Cleveland Clinic Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0864-9846","authenticated-orcid":false,"given":"Shrif","family":"Costandi","sequence":"additional","affiliation":[{"name":"Evidence\u2010Based Pain Management Research 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