It’s normal to experience aches and pains in our back, particularly as we get older. Roughly 75 to 85% of adults in the U.S. experience back pain sometime in their lifetime.

Our back pain may be a simple sign of an aging spine. Or sometimes, it may indicate we have a disease or injury. A visit to our doctor can help sort through what is normal from what may be a problem.

One common back pain progression begins with age-related degeneration of the spine. Spondylosis is a broad term that encompasses different types of spine degeneration.

“Over time, spondylosis in the lower back can cause lumbar spinal stenosis,” says Farzad Karkvandeian, DO. Dr. Karkvandeian is a doctor at the Philadelphia region’s Main Line Spine medical practice.

He continued, “The mild procedure can relieve lumbar spinal stenosis back pain for some patients who don’t respond to traditional conservative treatments.”

What Is Spondylosis?

Spondylosis results from normal “wear and tear” degeneration of soft structures and bones in our spine. It can appear in any part of the spine. However, it is most commonly observed in the neck (cervical) and lower back (lumbar) regions.

“Osteoarthritis of the spine” is an alternative name for spondylosis.

Patients with this degenerative condition may or may not experience symptoms. Most people don’t experience significant pain or other issues related to these arthritic changes, Dr. Karkvandeian noted. Spondylosis frequently evades detection until a patient undergoes an imaging scan triggered by a different condition.

“Nevertheless, some individuals experience a decline that ultimately results in discogenic pain,” he added. “This can limit a patient’s range of motion. In the lower back, it also indicates a patient may have lumber spinal stenosis.”

Research indicates that spondylosis affects approximately 90% of individuals aged 60 and above. Lumbar spinal stenosis is present in about 20% of this same population in the United States.

What Is Lumbar Spinal Stenosis?

Lumbar spinal stenosis (LSS) usually occurs from an injury or changes in the spine as we age. It can cause the spinal canal in the lower part of the back to narrow.

This narrowing can create pressure on nerves running through the hollow space in the center of the spine’s vertebrae. The pressure may lead to a set of lumbar spinal stenosis symptoms called pseudoclaudication, also called neurogenic claudication.

“When lumbar spinal stenosis occurs, it typically impacts the lower L3 to L5 levels of the spine,” Dr. Karkvandeian noted. “When patients have lumbar spinal stenosis, their legs will often feel heavy. Some describe it as if they were walking in cement.”

Other early symptoms may include cramping or discomfort in the leg(s) after a long walk. Those with the condition may also feel leg numbness or achiness after prolonged standing. In the later stages, pseudoclaudication may progress into even more severe leg pain that worsens when walking.

Illustration of lower spine S1 and L5 to L1 and spinal canal
Illustration of the lower portion of the spine from S1, L5 to L1, and illustration of the spinal canal.

Back Pain Relief with the mild Spine Procedure

According to Dr. Karkvandeian, one of the major causes of lumbar spinal stenosis is the presence of excess ligament tissue. This usually develops on the spine with spondylosis.

Over time, the strong ligament cords that help hold the spine’s bones together can become thick and stiff. As this happens, these thick ligaments can push into the spinal canal.

Spondylosis and lumbar spinal stenosis are not one in the same and shouldn’t be confused for each other. But Dr. Karkvandeian emphasized that it would be uncommon to find thickened ligaments and LSS without the presense of spondylosis.

“The mild procedure provides us with a minimally invasive way to remove that excess ligament tissue,” Dr. Karkvandeian says. “By doing that, we can restore space in the spinal canal. This relieves pressure on spinal nerves and the associated low back pain.”

Mild stands for minimally invasive lumbar decompression.

The mild back surgery procedure typically takes less than an hour. It is performed with specialized instruments through a single, tiny incision that measures less than the diameter of a baby aspirin (5.1 mm). mild® is normally completed in an outpatient surgery center using local anesthetic and light sedation.

“It’s important to remove the excess ligament tissue from both sides of the spinal segment during the procedure,” Dr. Karkvandeian emphasized. “There are no half-measures that are adequate when you want to maximize the long-term outcome for a patient.”

mild Procedure Durability

“Every patient is different, and the outcomes have varied,” says Dr. Karkvandeian. “We have witnessed individuals transition from experiencing extreme pain levels of 10 out of 10 to complete pain relief. When the procedure works well, it is an extremely gratifying experience for our patients and medical team.”

“Like with all procedures of this kind,” Dr. Karkvandeian added with caution, “it doesn’t work for everyone.” “However, a study of the five-year follow-up of Cleveland Clinic mild procedures shows encouraging results.”

Seventy-five individuals received mild® treatment at the Cleveland Clinic between 2010 and 2015. Of that group, only 9 needed additional lumbar surgical decompression during a 5-year follow-up afterwards¹.

“We will continue to learn more from clinical studies that will follow this one,” Dr. Karkvandeian said. “But for now, Cleveland Clinic’s experience provides an objective record of long-term success with mild. Our own direct experience with mild procedure outcomes with our patients remains positive.”


  1. Mekhail N, Costandi S, Nageeb G, Ekladios C, Saied O. The durability of minimally invasive lumbar decompression procedure in patients with symptomatic lumbar spinal stenosis: Long-term follow-up. Pain Pract. 2021 Nov; 21(8): 826-835 [PubMed]
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