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mild® Procedure

Villanueva Institute of Pain and Spine

mild® Procedure in Burbank, CA | Minimally Invasive Lumbar Decompression

The mild® Procedure, short for Minimally Invasive Lumbar Decompression, is designed for certain patients with lumbar spinal stenosis who have trouble standing or walking because the spinal canal has become too crowded.

This type of pain can change your whole routine. You may feel fine sitting down, then notice heaviness, aching, numbness, cramping, or weakness in your legs after walking a short distance. Grocery stores, parking lots, airports, errands, and neighborhood walks can become harder than they used to be. Many patients start leaning forward on a shopping cart or countertop because it gives their legs a little relief.

I am Dr. John Villanueva, double board-certified in PM&R and interventional pain management at Villanueva Institute of Pain and Spine (VIPS). When I evaluate lumbar spinal stenosis, I look closely at your symptoms, walking tolerance, imaging, prior treatments, physical exam, and the specific structure causing the narrowing.

The mild® Procedure treats one common contributor to lumbar spinal stenosis: thickened ligament tissue in the spinal canal called the ligamentum flavum. By removing a small amount of this excess tissue, the procedure can help create more room around compressed nerves without implants or traditional open spine surgery.

If you are looking for the mild® Procedure in Burbank, CA, call VIPS at (818) 669-8895 or request an appointment online. We are located in Burbank and see patients from Glendale, Pasadena, Van Nuys, Toluca Lake, Studio City, Sherman Oaks, North Hollywood, Sun Valley, La Cañada, La Crescenta, Los Feliz, Atwater Village, Silver Lake, Echo Park, and communities throughout the San Fernando Valley and greater Los Angeles area.

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What Is the mild® Procedure?

The mild® Procedure is a minimally invasive treatment for certain patients with lumbar spinal stenosis. It is also known as percutaneous image-guided lumbar decompression, or PILD.

During the procedure, small instruments are guided through a tiny incision in the lower back. Using imaging guidance, a small amount of bone and thickened ligament tissue is removed to reduce pressure in the spinal canal.

This is different from an injection. An epidural steroid injection may calm inflammation around irritated nerves, but mild® is intended to physically reduce a specific source of narrowing in the spinal canal. It is also different from traditional decompression surgery because it does not involve a large incision, implants, or major disruption of the spine’s structure.

The key is patient selection. The mild® Procedure is most useful when the symptoms and imaging point to lumbar spinal stenosis caused in part by thickened ligamentum flavum.

Symptoms the mild® Procedure May Help

The mild® Procedure is most often discussed when spinal stenosis causes neurogenic claudication. This means nerve compression in the lower back is causing leg symptoms that get worse with standing or walking.

Common symptoms include:

  • Low back pain with standing or walking
  • Leg pain, heaviness, fatigue, cramping, numbness, or tingling
  • Symptoms that improve when sitting down
  • Relief when leaning forward on a shopping cart, walker, counter, or bike
  • Trouble walking through stores, parking lots, airports, or longer hallways
  • Needing to stop and sit during errands or daily activity
  • Better comfort when bending forward compared with standing upright
  • Weakness or reduced confidence in the legs


Some patients mainly notice leg symptoms. Others have both back and leg symptoms. The pattern matters because mild® is chosen when the main problem fits lumbar spinal stenosis with ligament-related narrowing.

What Is Lumbar Spinal Stenosis?

Lumbar spinal stenosis means the spinal canal in the lower back has narrowed. When there is less room inside the canal, the nerves that travel through the lower spine can become crowded or compressed.

This narrowing can happen for several reasons, including arthritis, disc changes, bone spurs, thickened ligaments, and age-related changes in the spine. In patients who are candidates for mild®, the ligamentum flavum is an important part of the narrowing.

The ligamentum flavum is a band of tissue along the back of the spinal canal. Over time, it can thicken and buckle inward. When that happens, it can take up space where the nerves need room.

The “Shopping Cart Sign”

Many patients with lumbar spinal stenosis describe the same pattern: walking upright makes the legs ache, burn, cramp, tingle, or feel heavy, but leaning forward helps.

That is why people often feel better leaning over a shopping cart. Bending forward can temporarily open space in the spinal canal, which may reduce pressure on the nerves.

This detail is useful during diagnosis. It does not prove the diagnosis by itself, but it gives us an important clue when it matches the exam and imaging.

How I Diagnose Lumbar Spinal Stenosis Before mild®

Before I recommend the mild® Procedure, I want to make sure the symptoms and imaging match. Back and leg pain can come from several sources, including discs, joints, nerves, hips, circulation, muscles, and peripheral neuropathy.

During your evaluation, I may review:

  • Where your pain starts and where it travels
  • How far you can walk before symptoms begin
  • Whether sitting or leaning forward gives relief
  • Whether standing upright makes symptoms worse
  • Numbness, tingling, cramping, weakness, or balance changes
  • Prior physical therapy, medications, injections, or spine procedures
  • MRI, CT, or X-ray findings
  • Whether the ligamentum flavum is thickened
  • Whether stenosis is central, lateral recess, foraminal, or mixed
  • How symptoms affect errands, work, sleep, exercise, driving, and independence


Whenever possible, I prefer to review the actual images, not only the report. With mild®, the details on MRI or CT matter because the procedure targets a specific type of narrowing.

Who Are Good Candidates for the mild® Procedure?

You may be a good candidate for the mild® Procedure if your symptoms and imaging fit lumbar spinal stenosis caused in part by thickened ligamentum flavum.

Patients often come in with:

  • Leg pain, heaviness, numbness, tingling, cramping, or weakness with walking
  • Symptoms that improve with sitting or leaning forward
  • Difficulty standing for longer periods
  • Trouble walking through stores, parking lots, airports, or daily errands
  • MRI or CT findings showing lumbar spinal stenosis
  • Imaging that shows thickened ligamentum flavum
  • Symptoms that have not improved enough with conservative care
  • A desire for a less invasive option before considering open spine surgery


The consultation is where we decide whether the mild® Procedure fits your situation. Some patients need physical therapy, injections, medication review, EMG/NCS testing, surgical evaluation, or another type of treatment instead.

What Are the Treatment Options?

mild® Procedure vs. Epidural Steroid Injections

Epidural steroid injections and the mild® Procedure can both be used in the care of lumbar spinal stenosis, but they work differently.

An epidural steroid injection places anti-inflammatory medication near irritated spinal nerves. It can be helpful when nerve inflammation is part of the pain pattern.

The mild® Procedure addresses crowding in the spinal canal caused by thickened ligament tissue. Instead of only calming irritation, it removes a small amount of the tissue contributing to compression.

Some patients try epidural injections before mild®. Others may be evaluated for mild® when injections have not provided enough lasting improvement and imaging shows the right anatomy.

Traditional lumbar decompression surgery can be very helpful for the right patient, especially when stenosis is severe or there are structural problems that need a surgical approach.

The mild® Procedure is less invasive. It uses a small incision and image-guided instruments to remove excess ligament tissue. It does not require implants, fusion, or a large surgical exposure.

That distinction can matter for patients who are not ready for open surgery, are trying to avoid a larger operation, or have medical concerns that make a less invasive option attractive. Still, the choice depends on anatomy. If your imaging shows a problem that mild® is not designed to treat, I will explain that clearly.

The mild® Procedure is specific. It is designed for lumbar spinal stenosis when thickened ligament tissue is part of the compression.

If your pain is mainly from a herniated disc, severe instability, advanced spondylolisthesis, fracture, infection, tumor, hip arthritis, vascular disease, peripheral neuropathy, or a different spine problem, another plan may be more appropriate.

What Happens During the mild® Procedure?

The mild® Procedure is performed with image guidance. The treatment area is cleaned and numbed, and a very small incision is made in the lower back.

Through that opening, specialized instruments are guided to the area of narrowing. A small amount of bone and thickened ligament tissue is removed to create more space in the spinal canal and reduce pressure around the nerves.

The procedure is typically performed in an outpatient setting. Before treatment, I will review the target level or levels, what to expect that day, how to prepare, and what recovery usually looks like.

How VIPS Approaches the mild® Procedure

At VIPS, I look at mild® as one tool in a broader spine care plan. It can be a strong option for the right patient, but the decision has to be grounded in symptoms, imaging, and function.

When you choose VIPS, you can expect:

I am double board-certified in PM&R and interventional pain management. My PM&R training helps me evaluate walking tolerance, movement, rehabilitation, strength, nerve symptoms, and daily function. My interventional training allows me to perform targeted spine procedures when they fit the diagnosis. My qualifications extend beyond double-board certification. As a Certified Life Care Planner, I have advanced specialized training in evaluating the long-term medical, rehabilitation, and future care needs of individuals with complex injuries and disabilities, further strengthening the expertise I bring to medical-legal consulting and expert witness services.

The mild® Procedure depends on the right anatomy. I review your MRI or CT for stenosis, ligamentum flavum thickening, nerve compression, and other spine findings that may affect the plan.

I want to know how far you can walk, how long you can stand, what happens when you lean forward, and which daily activities have become harder.

Care may include physical therapy, medication management, epidural steroid injections, EMG/NCS testing, the mild® Procedure, spinal cord stimulation, basivertebral nerve ablation, radiofrequency ablation for other targets, or surgical referral when appropriate.

I will explain what your imaging shows, how it matches your symptoms, and why mild® does or does not make sense for you.

Many patients with lumbar stenosis have been told they are “just getting older” or that they need to live with shorter walking distances. I want you to understand your options clearly.

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What Should You Expect After the mild® Procedure?

Recovery after mild® is usually much shorter than recovery after open decompression surgery, but your body still needs time to settle.

You may have soreness at the treatment area. My team will give you instructions about activity, medications, wound care, and follow-up. Many patients are encouraged to walk as tolerated, but specific restrictions depend on your condition and procedure details.

Improvement can be gradual. Some patients notice better standing and walking tolerance within weeks, while others need more time, especially if symptoms have been present for a long time or if more than one pain source is involved.

After the procedure, I want you to pay attention to practical changes. Can you stand longer? Walk farther? Get through the grocery store with fewer stops? Run errands with less leg heaviness? Spend less time searching for a place to sit? Those details tell us whether the treatment is improving function.

How Long Do mild® Procedure Results Last?

Results vary from patient to patient. For properly selected patients, the mild® Procedure is intended to provide lasting improvement in walking and standing tolerance by reducing ligament-related narrowing in the spinal canal.

Your outcome depends on the severity of stenosis, other spine findings, strength, activity level, medical history, and whether there are additional pain sources. Some patients have meaningful improvement for years. Others may need ongoing care for arthritis, discs, nerves, or other spine conditions.

If symptoms change over time, I reassess the pattern. Spine care should stay connected to what your body is doing now.

mild® and Your Broader Treatment Plan

The mild® Procedure can help create more room in the spinal canal, but the best results often come when the rest of the plan supports better movement.

Depending on your needs, care may include walking progression, physical therapy, home exercise, medication review, posture and pacing strategies, additional injections, nerve testing, or coordination with another specialist.

Lumbar spinal stenosis can affect confidence. Many patients stop walking because they are afraid their legs will give out or the pain will flare. Part of recovery is rebuilding trust in your body, one practical step at a time.

mild® Procedure in Burbank, CA

VIPS is located in Burbank, CA, in the Magnolia Park neighborhood. The office is designed to feel welcoming and personal, with comfortable seating, warm finishes, and original artwork from patients who are working artists.

This is a place where your story has time to be heard. I live and work in Burbank, and I care about building a practice where patients feel known, respected, and well-informed.

We see patients from Burbank, Glendale, Pasadena, Van Nuys, Toluca Lake, Studio City, Sherman Oaks, North Hollywood, Sun Valley, La Cañada, La Crescenta, Los Feliz, Atwater Village, Silver Lake, Echo Park, and communities throughout the San Fernando Valley and greater Los Angeles area.

Burbank mild® Procedure FAQs

To schedule a mild® Procedure consultation in Burbank, CA, call (818) 669-8895 or contact VIPS online today. A careful evaluation can help you understand whether minimally invasive lumbar decompression fits your symptoms, imaging, and goals.

mild® stands for Minimally Invasive Lumbar Decompression. It is also known as percutaneous image-guided lumbar decompression, or PILD.

The mild® Procedure treats lumbar spinal stenosis when thickened ligamentum flavum is contributing to narrowing in the spinal canal and symptoms such as leg pain, heaviness, numbness, tingling, or difficulty walking.

The shopping cart sign refers to feeling better when leaning forward on a shopping cart, walker, counter, or similar support. This forward-bent position can temporarily open space in the spinal canal for some patients with lumbar spinal stenosis.

No. The mild® Procedure is not an injection. It is a minimally invasive decompression procedure that removes a small amount of tissue contributing to spinal canal narrowing.

mild® is a minimally invasive procedure, but it is different from traditional open decompression surgery. It uses a small incision, image guidance, and no implants. Some patients still need surgical evaluation depending on their anatomy and symptoms.

The mild® Procedure is mainly intended to improve symptoms from lumbar spinal stenosis, especially leg heaviness, pain, numbness, tingling, cramping, or walking difficulty. Some patients also have improvement in low back discomfort, depending on the pain source.

Many patients are encouraged to walk as tolerated after the procedure, but instructions vary. I will give you specific guidance based on your procedure, medical history, and symptoms.

For properly selected patients, mild® may provide a less invasive option before considering open decompression surgery. If your imaging shows a condition that needs surgical evaluation, I will explain why.

Prior spine surgery does not automatically rule out treatment, but it makes the evaluation more detailed. I will review your operative history, imaging, anatomy, and current symptoms before discussing whether mild® is appropriate.

The cost of the mild® Procedure in Burbank can vary depending on imaging, insurance benefits, authorization requirements, procedure setting, and the number of levels treated. During your consultation, my team can help you understand what information may be needed for scheduling, approval, and cost review.

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