How the MILD Procedure Helped an 86-Year-Old Woman Get Her Life Back

In early 2023, 85-year-old Jackie Freehart reached to put something away in a kitchen cupboard and fell backwards, injuring her back. It was so painful that she needed her son’s help to get up from the kitchen floor. After two days of waiting for the pain to stop, she went to the hospital to get checked out. Jackie was seen by Atlantic Orthopaedics pain management specialist, Dr. Lehn, who told her that she had Spinal Stenosis, a condition that occurs when the channel inside the spine narrows, putting pressure on the spinal cord and nerves, and causing pain when standing or walking. Spinal Stenosis can be the result of an injury like Jackie’s, or just the normal wear and tear that comes with aging.

Dr. Lehn listened closely to Jackie’s story and suggested she try conservative treatments for the pain first, rather than rushing into surgery. “I was so impressed with Dr. Lehn,” Jackie said. “He doesn’t rush but takes the time to explain things. He doesn’t give orders. He gave me a choice.” She decided to try physical therapy, and then Cortisone shots, but found that neither one helped, at least not for long. “Getting in and out of bed was the worst thing,” Jackie said. “I just couldn’t get comfortable. The only position I could sleep in was lying on my side, but turning from one side to the other was painful and difficult.”

At her next visit, Dr. Lehn told her about a procedure for Spinal Stenosis called MILD, short for minimally invasive lumbar decompression. MILD is a minimally invasive alternative to traditional spinal surgery where the surgeon inserts a spinal decompression device through a tiny incision in the back, using it to remove the tissue that’s pressing on the spinal nerves. The procedure takes less than an hour and is performed with local anesthesia so patients can go home the same day. Dr. Lehn gave Jackie a brochure about MILD to take home and asked her to think about it. In the meantime, she continued to get Cortisone shots in the hopes that it would provide relief.

When she returned to Dr. Lehn a few months later for her Cortisone shot, he mentioned that he had done the MILD procedure on a 90-year-old patient the day before and she had walked out of the hospital on her own. “I had read the brochure and I Googled it,” Jackie said, “and we talked about it twice before I got serious about it. He didn’t try to coerce me into it.” About 7 months after her fall and still in pain, Jackie made up her mind to undergo the procedure.

“Dr. Lehn explained everything, so I knew what to expect,” she said. “He was very reassuring and I was not a bit nervous when I went in.” Dr. Lehn performed the MILD procedure at NECOS in Portsmouth in August of 2023. Jackie woke up soon after and walked out with the help of a walker. She was still in some pain when she left the hospital and it continued for the next day. But two days after the surgery, Jackie reported, she was pain-free. “The recovery was almost miraculous!” she said. “Now I have no pain going to bed. I’m not fearful about it. I can sleep and I feel like myself again.” Jackie can get around now with just a cane. She recently attended a baby shower and is back to walking at the mall three days a week. “I can cook again, which is my passion,” she said. “I have company over now.”

When asked if she would recommend the MILD procedure and Dr. Lehn to her friends, Jackie didn’t hesitate. “I can’t say enough wonderful things about Dr. Lehn. The whole staff was incredible, very helpful and kind,” she said. “This procedure is worth it for anyone having this pain, because quality of life is so important.” Jackie was so pleased with the care she received that she wanted to show her gratitude to everyone at Atlantic Orthopaedics. “I didn’t know what to do other than say thank you,” she said. “I told my son I wanted to do something more, and so we went out and got a great big basket of cookies and brought them for the staff.” Now, eight months after she had the procedure, Jackie remains pain-free. “I’m so glad I had it done,” she said. “I feel like I have my life back.”

Relief From Lower Back Pain With SI Fusion

Living with chronic lower back pain can have a profound impact on not just your physical well-being, but your overall quality of life. Many people suffer from back pain due to dysfunction in the sacroiliac (SI) joint, which connects the bottom of the spine (sacrum) to the pelvis (ilium). These two joints, one on each side act as a shock absorber for the spine and play a crucial role in stability and weight bearing ability, transferring pressure from the lower back to the legs. The SI joint can be damaged by traumatic injury, a degenerative condition, or tissue loosening from things such as connective tissue disorders and pregnancy. Patients with SI dysfunction will feel pain in the low back, especially when walking, standing up from a seated position, or lifting. Other symptoms can include numbness or tingling in the lower extremities; pain in the pelvis, hip, or groin; pain radiating down the legs; or buckling in the legs.

Diagnosing SI Dysfunction

Because low back pain can be a symptom of other conditions like sciatica, diagnosis is usually done with a physical exam, followed by an injection that will temporarily block the pain if it’s originating in the sacroiliac joint. In some cases, the pain can be managed with anti-inflammatory medications, physical therapy, or steroid injections, but for patients who haven’t responded to those treatments there is a minimally invasive procedure called SI Fusion that may offer sustained relief.

What is the SI Fusion Procedure?

SI Fusion, short for sacroiliac joint fusion, is a minimally invasive procedure in which the surgeon inserts an implant into the SI joint space. Guided by real-time imaging, a small incision is made and the implant is fixed in place, fusing the sacrum to the ilium in order to limit movement. This fusion, by restricting excessive motion in the SI joint, restores stability and alleviates pain.

What Does the Recovery From SI Fusion Involve?

Because the procedure is minimally invasive, the risk of complications is low and recovery times are quicker than with traditional open surgery. Patients can expect to be mobile immediately after the procedure, and most experience rapid pain relief. Post-operative physical therapy may be recommended to restore function in the joint and aid recovery.

Below, a Q&A about SI Fusion with pain management specialist Dr. Lehn:

How does this procedure benefit your patients?

15-30% of low back pain comes from the SI joint. The SI joint can be a difficult pain to treat as many times PT, medications, and injections only provide temporary relief.

Who is a good candidate for an SI fusion?

If a patient has 90% relief of pain from a SI injection and the pain keeps returning despite exercise, medications, and repeated injections, then they can be considered for SI fusion.

Where do you perform this procedure?

The procedure is performed in the operating room but is done with minimal sedation, and the patient can walk out of the recovery room and go home the same day as the procedure.

Do you have a recent patient success story to share?

One patient had her left side done in June and felt so good she came back in September to have the other side done! She is very happy and back to her very active lifestyle.

Anything else you’d like current or future patients to know about this procedure and how it could benefit them?

This is a very minimally invasive procedure with minimal downtime. The pain from the procedure is minimal. Unfortunately, intense activity is limited for 6 weeks but patients are up and walking the same day. Fusions sound really big and dangerous, but it is essentially a stabilization procedure. SI joints are often painful due to excessive movement. The SI stabilization procedure takes away the additional movement and helps return the patient to a normal functioning joint.For patients grappling with chronic lower back pain caused by SI dysfunction, the SI Fusion procedure can provide long-term pain relief and renewed quality of life. If you suffer from pain that hasn’t responded to non-surgical treatments, schedule a consultation with Dr. Lehn to explore whether SI Fusion is right for you. Take your first steps toward a pain-free future!

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?

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.