A minimally invasive lumbar decompression procedure after an interspinous spacer device implantation: an uncommon order of treatment with a successful outcome

A patient with lumbar spinal stenosis (LSS) was referred to our clinic due to refractory low back pain, radicular pain, and neurogenic claudication despite conservative treatment with medical management. Imaging of the lumbar spine revealed spinal canal and foraminal stenosis. Multiple epidural steroid injections (ESI) were performed which did not resolve her condition. We offered her an Implantation of an Interspinous Spacer Device (ISD) since her primary symptoms were predominantly characteristic of radicular pain. Her radicular symptoms improved but experienced worsening of her lower back pain and neurogenic claudication. For these reasons, we then offered her a Minimally Invasive Lumbar Decompression (MILD) procedure. Though both procedures share the same incisional approach, the first one deploys an implant in the interspinous process, as opposed to the MILD procedure which does not. We therefore describe the intricacies of performing a MILD procedure after an ISD implant and share the patient's outcome.