Tag: open decompression

J Neurosurg Spine 44:55–61, 2026

This propensity score–matched retrospective study compares minimally invasive lumbar decompression (mild) with open decompression for lumbar spinal stenosis at a tertiary multisite center from 2005–2024. Primary outcomes included pain change (NRS), reoperation, and perioperative complications, with MCID defined as 30% NRS improvement.

Results show open decompression yielded greater pain improvement, higher MCID attainment, and lower overall reoperation rates, while mild had fewer durotomies but more neurological deficits. The authors recommend independent prospective studies to validate comparative efficacy and cost-effectiveness and note limitations including retrospective design and incomplete radiographic severity data.

Open decompression is more effective than the mild (minimally invasive lumbar decompression) procedure for achieving clinically significant pain improvement in patients with symptomatic lumbar spinal stenosis (43.1% vs 22.2% reached MCID; p < 0.001).

Reoperation rates are higher after the mild procedure compared to open decompression (46.2% vs 29.3%; p = 0.008), indicating less durable symptom relief with mild.

Pain outcomes favor open decompression, with patients reporting lower pain scores at last follow-up (mean NRS 2.3 vs 5.4; p < 0.001) and greater overall improvement from baseline.

Complication profiles are similar overall, but mild is associated with higher rates of postoperative neurological deficits (6.3% vs 0.6%; p = 0.003), while open decompression has a higher rate of durotomy (2.9% vs 0%; p = 0.024).

Procedure characteristics: The mild procedure is performed percutaneously through a small incision, typically by pain medicine physicians, and targets debulking the ligamentum flavum without muscle dissection.

Study limitations include retrospective design, incomplete matching for stenosis severity and baseline pain, and missing data on some outcomes, suggesting a need for prospective studies.

Existing literature on mild is often industry-sponsored and lacks direct comparison to open decompression; independent studies show mild may be less effective and more likely to require further surgery.

Clinical recommendation: Open decompression remains the gold standard for patients with symptomatic lumbar spinal stenosis who fail conservative management, while the mild procedure may offer less pain relief and higher reoperation risk.