MILD Procedure for Lumbar Spinal Stenosis
The MILD procedure is minimally invasive lumbar decompression for lumbar spinal stenosis — walking pain that eases when you sit or lean forward. If therapy has plateaued, request a consultation with Dr. John Smirniotopoulos to review whether this alternative to laminectomy is a fit.
Typically outpatient, with light sedation rather than general anesthesia
The procedure
Minimally invasive lumbar decompression for stenosis
MILD is percutaneous lumbar decompression: thickened ligamentum flavum is removed through a tiny opening so the canal has more room. It is one option among spine treatments at Full Motion Joint and Spine — not hardware, and not a promised result.
Not a large laminectomy
No implants in the usual MILD visit. Facet-driven twisting pain may need medial branch ablation instead.
MedStar procedures
Done in the MedStar hospital setting. Visit flow is on the Locations page.
Request a consult
Request a consultation so candidacy is decided in person — not from this page.
The canal
Neurogenic claudication — walking pain from stenosis
Lumbar spinal stenosis can cause leg and back pain that worsens with standing or walking (neurogenic claudication) and eases with sitting. Thickened ligament crowding the canal is the usual MILD story — not every “stenosis” line on an MRI.
The opening
Ligamentum flavum removed through a tiny opening
Through a tiny opening, thickened ligament tissue is removed to relieve pressure on the nerves — typically without general anesthesia. This is image-guided percutaneous lumbar decompression, not an open laminectomy.
Candidacy
A consult if walking distance keeps shrinking
People ask about MILD when they want an alternative to laminectomy after conservative care. Dr. John Smirniotopoulos decides candidacy in person — not from this page.
Often discussed at consult
- Walking or standing pain that eases when you sit or lean forward
- Imaging support for ligament-driven lumbar stenosis
- Interest in a small-opening option instead of a large decompression
Candidacy is confirmed in person — not from this page.
Not every stenosis report
Instability, a large disc fragment, or pain from another structure can point elsewhere.
New bowel or bladder loss, saddle numbness, or rapidly worsening weakness needs urgent care — not this page.
The visit
Your MILD visit, start to finish
Before you arrive
Imaging review of the canal and ligament. Simple prep. See Locations.
The day of treatment
Outpatient small-opening decompression. Arrange a ride home.
Going home
Typically same-day discharge when the visit goes as planned.
Follow-up
Most people return to light activity within a few days. Timelines vary. No rate is quoted here.
Afterward
Recovery after the MILD procedure
This is not fusion recovery. If MILD is not the match, options include continued conservative care, facet treatment, or surgical evaluation with your existing team.
Care led by
Dr. John Smirniotopoulos
MILD is performed by a dual board-certified interventional and diagnostic radiologist, Associate Professor of Radiology at MedStar Georgetown University Hospital, fellowship-trained in vascular and interventional radiology (2020). Credentials are on the About page.
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Dual board-certified Interventional & Diagnostic Radiology
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American Board of Radiology
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Associate Professor of Radiology MedStar Georgetown
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Society of Interventional Radiology SIR
Before you book
MILD questions we hear at consult
What is the MILD procedure?
Minimally invasive lumbar decompression for selected ligament-driven spinal stenosis. It is not a large laminectomy. Results vary.
Can it help neurogenic claudication?
That walking-then-sitting pattern is the usual consult. Candidacy is confirmed in person — not from this page.
Is MILD an alternative to laminectomy?
For selected people, yes — it is discussed as a smaller option. It is not for every stenosis MRI.
Is it outpatient?
Yes. MILD is typically outpatient with same-day discharge when the visit proceeds as planned.