A Walk On The MILD Side

Minimally invasive therapy alleviates pain, weakness, and helps you walk.

To the uninitiated, Pascasio “Chino” Pagan might look a little out of place hanging around a pool hall such as Penny Annie’s in Melbourne. Many have learned the hard way, though, that even at 87 years of age, Pascasio can still clean a table with the best of them.

“I’ve still got it,” says Pascasio, who grew up playing competitive pool in Puerto Rico and has a closet full of trophies to show for it. “I went by (Penny Annie’s) not long ago to see some friends. I played one of them and beat him in three straight games.”

That recent visit to Penny Annie’s was a triumphant return to the pub for Pascasio. It came after he had been laid up at home for a few weeks as a result of a back problem that struck suddenly while he was out doing yardwork.

“Yardwork is my father’s exercise,” explains Pascasio’s daughter Myriam. “He’s also active in a lot of other ways. He definitely gets out and plays pool whenever he can, and he loves to cook. He even goes to the grocery store and buys his own groceries. 

“But after he hurt his back, he was completely limited in what he could do. He couldn’t do his yardwork or cook because he couldn’t stand for more than about 15 minutes.”

Pascasio’s back pain was so great that when he did try to stand, he could not straighten himself at the waist and wound up leaning forward. As a result, he often lost his balance and nearly fell on a few occasions.

Since undergoing the MILD back procedure, Pascasio is playing championship-caliber pool again.

Since undergoing the MILD back procedure, Pascasio is playing championship-caliber pool again.


“On a scale of one to 10, my back pain was a 10,” Pascasio complains. “I still tried to do some things, but when I went to the store, I needed to take a break and sit down in a chair for a while because I just couldn’t take the pain anymore.”

Pascasio endured the pain and the limitations it caused only for a week or so before seeking medical attention. His initial visit was to his primary care physician, who suggested he visit Nicholas Giordano, MD, at Central Florida Spine & Pain in Melbourne.

In the Thick of It 

“When Pascasio first came to us, he was experiencing severe back pain as well as leg pain and even weakness and stiffness in his legs,” Dr. Giordano reports. “His legs were so weak and stiff that they were giving out on him at times.”

To determine the cause of those symptoms, Dr. Giordano performed a thorough examination that included an MRI, which revealed that Pascasio was suffering from lumbar spinal stenosis caused by a thickening of the ligaments in the spine.

Known clinically as ligamentum flavum hypertrophy, the condition specifically affects the ligaments that help people maintain an upright posture and ensure their vertebral column straightens after bending.

As he always does, Dr. Giordano initially took a conservative approach to treating the problem. However, when epidural injections failed to alleviate Pascasio’s pain, weakness and stiffness, Dr. Giordano suggested a slightly more advanced option.

“What I presented to him was a procedure that we call MILD, which stands for minimally invasive lumbar decompression,” Dr. Giordano educates. “It’s a procedure that’s designed particularly for people over the age of 80 who are experiencing a variety of symptoms.

“It’s not just for people who are experiencing pain. This procedure is for anyone like Pascasio who is having trouble walking because their legs get heavy and achy and they start to feel as if their legs are going to give out on them.

“In a lot of cases, these people tend to feel as if they’re walking in quicksand. But if they go to the supermarket and start to push a shopping cart in front of them, all of a sudden, those problems go away, and they start to feel as if they can walk forever.

“That’s because that forward flexion that comes from pushing the shopping cart opens up the spinal canal the same way that this MILD procedure can. 

“The difference is that this procedure can also put power back in your legs and improve your quality of life permanently,” the doctor explains.

As it was with Pascasio, the MILD procedure can be performed using a local anesthetic if the patient has not been cleared for sedation. Once the patient is numbed or sedated, the physician makes a small incision in the back.

“We call it an incision, but it’s hardly even that,” Dr. Giordano informs. “It’s simply an entry point that is smaller than the hole on a piece of loose-leaf paper. It’s a little hole punch that’s about the size of a baby aspirin, and that’s what we work through.”

Through that tiny entry point, the physician uses x-ray guidance to direct a surgical device into the spinal canal. At the end of the device is a tool that scrapes the thickened ligaments causing the pain.

“A simple way to explain what we’re doing is we’re removing the kink from a drinking straw,” Dr. Giordano educates. “It’s a very safe procedure that only takes about 20 minutes. The results are amazing in that it really helps to restore quality of life.

“If you’re having this kind of back pain and weakness in your legs and you’ve tried epidural injections and ablations and they’ve failed, I urge you to get some imaging done and see if this simple procedure can resolve those problems because it often does.”

Straight Shooter 

Studies show that the MILD procedure alleviates back and leg pain and weakness in the legs in about 79 percent of patients who receive it. Pascasio, who underwent the procedure this past fall, is among those who are benefitting from it.

“I feel great now,” Pascasio exudes. “I’m being responsible and taking it easy, but I can walk normally again without any pain. I can also walk longer distances because I don’t have that pain and weakness anymore.

“The procedure even helped me with my pool game because I can shoot straight again. Before I had the procedure, if I tried to play, I would miss my shot because it hurt to stand up straight.”

Dr. Giordano also arranged for Pascasio to undergo physical therapy. The regimen included tips on how to properly bend and kneel so Pascasio can avoid further damage to his back while doing yardwork.

“I think Dr. Giordano is a great doctor. I like him a lot,” Pascasio concludes. “I trust him, and I definitely recommend him. His staff is very good, too. Everyone is wonderful. They took good care of me and I really appreciate everything they did for me.”

© FHCN article by Roy Cummings. Photo by Jordan Pysz. mkb
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    • Central Florida Spine & Pain

      If you’re in pain, Central Florida Spine & Pain can help. The highly skilled, friendly, and compassionate team at Central Florida Spine & Pain can effectively address your pain, so you can get back to enjoying your life to the ful... Read More

    • Nicholas Giordano, MD

      Nicholas Giordano, MD, is a board-certified interventional pain management specialist. He earned his bachelor’s degree in biological science from the State University of New York at Binghamton in 2006 and his medical degree from St. Georg... Read More