Feasibility of the Minimally Invasive Lumbar Decompression Procedure in a Lumbar Stenosis Patient With Radiographic Evidence of Spinal Instability

TL;DR

This case report shows that a minimally invasive procedure can provide long-term pain relief for a high-risk patient with spinal stenosis and instability.

Contribution

First reported case of MILD in a patient with radiographic spinal instability.

Findings

MILD provided sustained pain relief for over a year in a high-risk patient.

Spinal instability may not be an absolute contraindication for MILD.

Multidisciplinary evaluation enabled safe treatment in a poor surgical candidate.

Abstract

Lumbar spinal stenosis (LSS) can be challenging to treat in certain patient populations, particularly in patients for whom medical management is ineffective and surgical interventions carry a high risk of complications. This case report describes an 83-year-old woman with rheumatoid arthritis and LSS who presented with neurogenic claudication. Diagnosis was confirmed by physical examination and imaging, revealing canal stenosis and lumbar instability. Conservative measures failed to improve her symptoms, and she was deemed a poor surgical candidate given her age, advanced arthritis, and her current immunotherapy. Despite lacking supporting evidence, spinal instability has been considered a contraindication for minimally invasive lumbar decompression (MILD). However, following a multidisciplinary discussion, MILD was offered to the patient as a treatment option. To our knowledge, this is the first case of MILD in a patient with lumbar instability, resulting in sustained pain relief lasting over a year.

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