MILD® Percutaneous Image-Guided Lumbar Decompression Versus Epidural Steroid Injections in Patients With Lumbar Spinal Stenosis Exhibiting Neurogenic Claudication
Overview
- Phase
- Not Applicable
- Intervention
- MILD Procedure
- Conditions
- Spinal Stenosis, Lumbar Region, With Neurogenic Claudication
- Sponsor
- Vertos Medical, Inc.
- Enrollment
- 302
- Locations
- 12
- Primary Endpoint
- Number of Participants Who Achieved a Clinically Significant Improvement in the Oswestry Disability Index at 12 Months
- Status
- Completed
- Last Updated
- 8 years ago
Overview
Brief Summary
Study Objective: To compare patient outcomes following treatment with either the MILD procedure or epidural steroid injections (ESIs) in patients with painful lumbar spinal stenosis exhibiting neurogenic claudication and having verified ligamentum flavum hypertrophy as a contributing factor.
Investigators
Eligibility Criteria
Inclusion Criteria
- •65 years or older and a Medicare beneficiary.
- •Patients experiencing neurogenic claudication symptoms for at least 3 months duration which has failed to respond or poorly responded to physical therapy, home exercise programs, and oral analgesics.
- •LSS with neurogenic claudication diagnosed via:
- •Symptomatic diagnosis and
- •Radiologic evidence of LSS with unilateral or bilateral ligamentum flavum \>2.5mm confirmed by pre-op MRI or CT performed within 12 months of baseline visit.
- •Patients with comorbid conditions commonly associated with spinal stenosis, such as osteophytes, facet hypertrophy, minor spondylolisthesis, foraminal stenosis, and/or disk protrusion may be included unless the treating physician has determined that the condition is too advanced.
- •Available to complete 6 month and one year follow-up visits.
Exclusion Criteria
- •ODI Score \< 31 (0-100 ODI Scale).
- •NPRS Score \< 5 (0-10 NPRS Scale).
- •Prior surgery at any treatment level.
- •History of recent spinal fractures with current related pain symptoms.
- •Patients with Grade III or higher spondylolisthesis.
- •Motor deficit or disabling back and/or leg pain from causes other than LSS neurogenic claudication (e.g., acute compression fracture, metabolic neuropathy, or vascular claudication symptoms, etc.).
- •Unable to walk ≥ 10 feet unaided before being limited by pain. In this context, 'unaided' means without the use of a cane, walker, railing, wall, another person or any other means of walking assistance.
- •Patients previously randomized and/or treated in this clinical study.
- •Patients that have previously received the MILD procedure.
- •ESI during eight weeks prior to study enrollment.
Arms & Interventions
MILD
The MILD procedure is an image-guided minimally-invasive lumbar decompression
Intervention: MILD Procedure
Epidural Steroid Injection (ESI)
An epidural steroid injection (ESI) is a combination of a corticosteroid with a local anesthetic pain relief medicine.
Intervention: Epidural Steroid Injection
Outcomes
Primary Outcomes
Number of Participants Who Achieved a Clinically Significant Improvement in the Oswestry Disability Index at 12 Months
Time Frame: 12 months
Proportion of ODI Responders from baseline to one year follow-up in the treatment group versus the proportion of ODI Responders from baseline to one year follow-up in the control group. ODI Responders are defined as those patients achieving the validated Minimal Important Change in ODI score from baseline to follow-up as a clinically significant efficacy threshold.
Secondary Outcomes
- Number of Participants Who Acheived a Clinical Significant Improvement in the Numeric Pain Rating Scale (NPRS) at 12 Months(12 months)
- Number of Participants Who Achieved a Clinically Significant Improvement in the Zurich Claudication Questionnaire (ZCQ) at 12 Months(12 months)