Posterior Image-Guided Lumbar Decompression

Posterior Image-Guided Lumbar Decompression (PILD)

Posterior Image-Guided Lumbar Decompression (PILD)

PILD, short hand for Posterior Image-Guided Lumbar Decompression, is a minimally invasive procedure designed to treat symptomatic lumbar spinal stenosis (LSS). More specifically, lumbar stenosis resulting in a condition known as neurogenic claudication is the classic diagnosis for which PILD is indicated.

Neurogenic claudication (NC) is described as a sensation of heaviness, numbness, pain, or cramping in the back and/or legs upon ambulation, standing, or lying down for a specific amount of time or distance. The symptoms are relieved by a period of rest, but they return once the inciting activity is resumed. The reason that NC occurs is because of lumbar stenosis, which is compression of nerves due to arthritic build up in the spine.

It used to be that spine surgery was the only way to remove this arthritic build, but PILD, performed under x-ray image guidance, provides a minimally invasive technique to provide the same result. The procedure involves the use of needle instrumentation to remove small portions of bone (lamina) and ligament to open up space around the nerves being compressed. 

My MRI report reads that I have “stenosis” all over my spine. Does that make me a candidate for PILD?

Everyone will attain some degree of stenosis in their lifetime, but only some individuals will attain a degree to be considered “severe” or symptomatic. Your practitioner is specifically trained to evaluate your MRI and listen to your symptoms to determine whether you are a good candidate for the procedure.

I’ve heard of minimally invasive lumbar decompression (MILD) for lumbar stenosis--is that different from PILD?

No, MILD is a branding of the PILD technique.

I have pain as well as functional limitations--is PILD designed to help both?

Although it can help both pain and functional limitations, PILD is specifically designed to help with function. The objective is to improve walking/standing ability, and although pain is often improved also it is not a guarantee.

In addition to lumbar stenosis, I’m told I have disc/joint arthritis and foraminal stenosis--am I still a candidate for PILD?

Yes, in fact, it has been demonstrated that most patients who display success with PILD have multiple conditions. Although PILD does not address all of these other issues it is still effective in relieving symptoms due to LSS resulting in NC.