AOSM Running Man logo and Blog Title "New Pain Management Procedure"

Introducing MILD: life-changing relief from Spinal Stenosis

Does spinal stenosis make it painful for you to stand or walk for more than a few minutes? We’d like to tell you about a safe and effective treatment option called MILD, or minimally invasive lumbar decompression, offered by our pain management specialist Dr. Lehn

What is spinal stenosis?

Inside the spine is a hollow channel called the spinal canal that contains the spinal cord and nerves. Spinal stenosis occurs when the channel narrows, putting pressure on the spinal cord and nerves. In addition to pain, symptoms may also include weakness, numbness, and cramping in the lower back and legs. It’s most often caused by the normal wear and tear that comes with aging, but factors like arthritis and protruded discs can also lead to spinal stenosis.

How is it treated?

Spinal stenosis is often a progressing problem and it is difficult to predict if a patient will ultimately return to normal once symptoms begin. Many patients will benefit from treatments like physical therapy or steroid injections but the duration of benefit varies patient to patient. Some people manage the problem with minimal treatment while others need surgical decompression to relieve the pressure on the spinal cord. Understandably, many patients are hesitant to undergo invasive surgery, and may be worried about a hospital stay and a lengthy recovery time. 

What is MILD?

The MILD procedure for spinal stenosis is a minimally invasive alternative to traditional spinal surgery that has provided immediate relief and life-changing results for many patients. Guided by x-ray, Dr. Lehn inserts a spinal decompression device through a tiny incision in the back, using it to remove a portion of the tissue that’s pressing on the spinal nerves. The procedure takes less than an hour and, unlike traditional surgery, MILD is performed with local anesthesia and sedation, so you can go home the same day. Patients who undergo MILD typically experience minimal pain and much faster recovery times than with traditional surgery.

We sat down for a Q&A with Atlantic Orthopaedics’ Pain Management Specialist Dr. Lehn: 

Q: How does this new procedure benefit your patients? 

A: The MILD procedure is specifically for people with spinal stenosis diagnosed with a MRI leading to Neurogenic Claudication. Spinal stenosis is another word for a kink or tightening around the spinal nerves and Neurogenic claudication is pain that is present with standing or walking that improves with sitting. The goal of the procedure is to remove a portion of the tissue that is causing the spinal compression with a special tool using x-ray guidance. Once the patient heals they should expect a great increase in their ability to walk and stand! 

Other Benefits:

  • Almost immediate recovery from the procedure; full benefit takes 3-4 weeks.
  • 1 cm incision, no implants.
  • Minimal sedation for 30-45 minutes; walking home same day.
  • This procedure does not inhibit future surgery from being done.
  • 5-year studies show sustained relief of pain from this procedure.

Q: Do you have a recent patient success story you can share with us?

A: I just had a follow up with a 76 year old, male patient who is doing great! He was on the fence on whether he should do invasive surgery or the MILD. The patient had pain down both legs after standing and walking for just a short time.

His legs would also give out, and he had a tough time carrying things while walking. He was referred by Dr. Sutherland as he was very anxious about having a large surgical procedure so the MILD seemed like a great solution. 

He is now walking a mile with minimal pain!

Q: Who is a good candidate for the Minimally Invasive Laminectomy (MILD) Procedure? 

A: Patients who have trouble standing or walking, as long as the pain improves when they sit or lean forward on a shopping cart are good candidates for this procedure.

Q: What is the ideal age range for this procedure?

A: Any age. It is especially good for patients who do not consider themselves candidates for more invasive spinal surgery.

You might be a good candidate if: 

1. You have Spinal stenosis confirmed by MRI. 

2. You have difficulty standing and walking (but not pain lying down or sitting–that is something else.) 

3. You’ve had epidurals that work but are not long lasting.

Q: Where do you perform the MILD procedure? 

A: The procedure is performed in a surgery center. I currently perform the procedure at our state-of-the-art surgery center, NECOS.

Q. Is there anything else you’d like patients to know about this new procedure? 

A. It is very safe, with a rapid recovery, and a great option for people anxious about having invasive surgery. For the right patient it can be life changing!

If you have Spinal Stenosis and think you may be a good candidate for the MILD procedure, we invite you to schedule an appointment with Dr. Lehn for an evaluation. Why wait to get back to doing the things you love?

Torn ACL?

Torn ACL? Get Educated About BEAR

Atlantic Orthopaedics & Sports Medicine now offers patients an alternative to surgical reconstruction – a less invasive procedure called Bridge Enhanced ACL Restoration, or BEAR. Clinically tested and FDA-approved, this promising new procedure has been adopted by our own Dr. Tyler Welch, who performed the first BEAR surgery in the state of Maine!  Dr. Welch is an orthopedic surgeon and partner at Atlantic Orthopaedics who specializes in Sports Medicine, with a focus on the knee, shoulder, and hip. His mission is to restore his patient’s function through compassionate, evidence-based care.

Anterior cruciate ligament, or ACL, tears are one of the most common knee injuries, affecting more than 100,000 Americans each year. The ACL is a band of tissue that connects the thigh bone (femur) to the shinbone (tibia) inside the knee joint. It is one of the two cruciate ligaments, along with the medial collateral ligament (MCL), that stabilize the knee joint and prevent the tibia from sliding forward. ACL injuries most often occur when playing sports that involve sudden changes in direction, like:

  • Basketball
  • Soccer
  • Gymnastics
  • Downhill skiing

Pivoting with your foot firmly planted in place, landing awkwardly from a fall or jump, stopping suddenly, or getting a blow to the knee, along with wearing shoes that don’t fit properly or using ski bindings that aren’t correctly adjusted, can all increase your risk. ACL tears are also more common among women than men. Signs that you’ve torn the ligament, either partially or fully, include severe pain, a popping sensation, rapid swelling, and a feeling of the knee “giving way” when you put weight on it. 

If you think you’ve torn your ACL it’s important to be evaluated by an orthopedic doctor as soon as possible. It is possible that the ligament has been stretched or only partially torn, and in those cases the injury may respond to non-surgical treatments like ice, rest, elevation, or physical therapy. Unfortunately, a complete ACL tear can’t heal on its own. This is because the synovial fluid in the knee that keeps the bones from rubbing together also prevents the formation of blood clots needed for healing. Until recently, the only fix for a complete tear has been surgical reconstruction, where a tendon is taken from another part of the patient’s body, or from donor tissue, to reconstruct the torn ligament. 

We recently sat down with Dr. Welch to ask him a few questions about the new BEAR procedure. 

Q: Tell us Dr. Welch, how does this new procedure benefit your patients? 

A: This procedure can benefit patients because it is less invasive than a typical ACL reconstruction. Unlike typical ACL reconstruction, the patient does not need a “graft” to replace the ACL with the BEAR technique. As a result, the procedure may lead to less pain and swelling in the post-surgery period.

What makes BEAR unique is that it doesn’t require patient or donor tissue, instead using an implant made from collagen to bridge the gap between the torn ends of the ACL ligament. The implant is secured via suture, and the patient’s own blood is injected into it during the surgery to form a clot that surrounds the device. This facilitates cell proliferation and enables the body to heal itself. Within about eight weeks of surgery, the implant is absorbed, and replaced by the patient’s own tissue, which will continue to strengthen over time.

Q: Who is a good candidate for a BEAR Procedure? 

A: Anyone with an ACL tear is a candidate.  Based on recent research, individuals over the age of 20 are the best candidates. 

Q: Anything else you’d like patients to know about this new procedure? 

A: This is an exciting time in the world of ACL surgery. The BEAR procedure may be a game-changer, but the jury is still out. It is important for patients to know that we do not have any long-term clinical data regarding the BEAR technique. We do not yet know if the re-tear rates (failure rates) are higher in patients who have a BEAR compared to those who have a typical ACL reconstruction over the long term (more than five years).  However, current research (two year outcomes) has revealed similar success rates when comparing the BEAR technique to traditional ACL reconstruction. This is encouraging data that suggests that the BEAR technique is reliable.

Candidates for the BEAR procedure must have a complete rupture of the ACL. Eligible patients must also have a stump still attached to the tibia to allow for repair. Dr. Welch currently performs this procedure at York Hospital in York, ME and the BEAR procedure should be available soon at AOSM’s state-of-the-art orthopaedic ambulatory surgery center, NECOS in Portsmouth, NH. 

If you think you may be a good fit for the BEAR procedure, schedule an appointment for an evaluation with Dr. Welch. To learn more, click HERE.

Dr. Lehn talks about pain management.

What IS Pain Management?

Pain management providers see patients who are experiencing pain in the lower back, knee, head, hip, or neck, and who could be suffering from common conditions such as arthritis, fibromyalgia, migraines, sciatica, and much more. But what exactly is “pain management”?

We sat down with our board-certified interventional pain management provider, Dr. Andrew Lehn to ask him a few questions about his specialty: pain management. 

Q. What is the most common reason patients come to see you? 

A. I treat pain from head to toe but low back pain is the most common complaint. It is estimated that up to 80% of people will have significant low back pain at some point in their lives!

Q. What is pain management, in your professional opinion? 

A. Pain management is restoration. Pain means something is not functioning correctly. My goal is to try and figure out the source of pain and direct treatment to that location. Some conditions require surgery to correct but many things can improve by decreasing inflammation and facilitating healing. My goal is to restore someone back to how they felt before the pain started.

Q. What advice would you give a friend or a loved one if they are experiencing back or joint pain?

A. Exercise! Most painful conditions will improve with time. The goal is to strengthen the muscles and joints around a painful area so hopefully the pain does not increase. I tell people to think about joint pain like you would think about your heart. Imagine what your cardiologist would tell you: exercise, lose weight, eat healthy, decrease stress, prioritize good sleep. All these things will help your pain as well.

Q. Can you share a patient success story?

A. Recently, I had an elderly patient who was experiencing significant low back and buttock pain. She was frustrated because she was having difficulty doing her exercises and could not participate in physical therapy. Her Lumbar MRI had some degenerative issues and spinal narrowing but nothing too specific for the pain she was experiencing. She had pain around her Sacroiliac joint and her pain worsened with manipulation of the joint. I decided to inject her SI joint and she came back with significant relief. While her pain was not entirely gone, she felt that she could now do her exercises and return to physical therapy. Ultimately, that is the goal! I work alongside my patients to help get them going again and then they are better able to rehabilitate their injury and get back to functioning again. 

Pain management works best when the patient and doctor work together for the best solutions.

If you’re experiencing pain of any kind, talk to Dr. Lehn today to see how he can help you overcome your pain issues and get back to living a fuller, pain-free life.

Schedule a consultation HERE or give us a call, 603-431-1121.

Atlantic Orthopaedics & Sports Medicine