MILD Procedure and Balance Improvement in Spinal Stenosis
The MILD procedure can improve balance in patients with spinal stenosis, as it addresses the underlying neurogenic claudication and functional disability that contribute to balance impairments. 1
Evidence for Balance Improvement
The MILD procedure demonstrated statistically superior outcomes compared to epidural steroid injections in treating lumbar spinal stenosis with neurogenic claudication, with 58.0% of patients achieving clinically meaningful functional improvement at 1 year versus 27.1% in the control group (P < 0.001). 1
Patients with degenerative lumbar spinal stenosis exhibit significant heterogeneity in dynamic balance impairments, with approximately 31% reporting frequent balance problems that are directly associated with their walking function and disability. 2
The balance problems in spinal stenosis patients are multifactorial, involving impairments in anticipatory adjustment, sensory orientation, and stability of gait—all of which can potentially improve with effective decompression. 2
Mechanism of Balance Improvement
Surgical treatment for lumbar spinal stenosis, including minimally invasive procedures like MILD, has been shown to decrease fall risk as a positive short-term effect. 3
The MILD procedure specifically targets ligamentum flavum hypertrophy, which is a major contributor to central stenosis and the resulting neurogenic claudication that limits ambulation and impairs balance. 4, 1
By relieving the compression on neural elements, the MILD procedure can restore normal sensory input and motor function to the lower extremities, which are critical for maintaining balance during weight-bearing activities. 2
Clinical Considerations
The strongest association between balance impairment and specific balance control systems in spinal stenosis patients is with sensory orientation, suggesting that decompression procedures that restore neural function may have the greatest impact on balance. 2
Patients with spinal stenosis experience activity limitations related to increased pain during weight-bearing activities like walking and standing, which directly contributes to balance problems and fall risk. 2
The MILD procedure is particularly appropriate for patients with verified ligamentum flavum hypertrophy and central stenosis, and the functional improvements achieved include better walking ability, which is intrinsically linked to balance. 1
Important Caveats
While the MILD procedure improves overall function and walking ability, the specific magnitude of balance improvement may vary considerably between individuals, as balance impairments in spinal stenosis patients show large inter-individual variation. 2
The procedure is most effective when patients have documented ligamentum flavum hypertrophy as the primary cause of stenosis, and may be less effective if other structural pathologies (such as severe facet arthropathy or spondylolisthesis) are the predominant contributors to symptoms. 1
Balance improvement should be considered a secondary benefit of the overall functional restoration achieved through decompression, rather than the primary indication for the procedure. 1, 2