Chronic lower back pain is one of the most common reasons adults visit a physician, and for a large share of aging patients in Delaware, the underlying cause is lumbar spinal stenosis.
This condition, a narrowing of the space around the spinal nerves in the lower back, can turn everyday activities like walking, standing, or gardening into a source of constant discomfort.
For years, patients facing this diagnosis had a limited menu of options: manage the pain with medication, pursue physical therapy with mixed results, or consider invasive spine surgery with a lengthy recovery.
The Minimally Invasive Lumbar Decompression procedure, known as MILD, has changed that equation, and recent case volume data shows Delaware is home to some of the most experienced providers offering it.
MILD is an outpatient, image-guided procedure developed to treat lumbar spinal stenosis without the need for open spine surgery.
Using fluoroscopic (X-ray) guidance, a physician accesses the affected area of the spine through an incision smaller than the size of a baby aspirin. Through this small portal, the physician removes small portions of bone and thickened ligament tissue that are compressing the spinal nerves, restoring space in the spinal canal and relieving the pressure causing the patient's pain.
The appeal of MILD lies in what it avoids. There are no large incisions, no spinal implants, and no general anesthesia required for most patients.
The procedure typically takes about an hour, and many patients are up and walking again within a short time afterward.
For patients who are not good candidates for open spine surgery, either because of age, other health conditions, or a simple preference to avoid a major operation, MILD has become a meaningful middle path between conservative treatment and surgical intervention.
Because MILD is a specialized, image-guided procedure, outcomes and patient experience can vary significantly depending on how many of these procedures a given physician and facility have actually performed.
That is where Delaware's case volume data becomes worth paying attention to.
Many patients live with the symptoms of lumbar spinal stenosis for months or even years before receiving an accurate diagnosis, in part because the symptoms can be mistaken for general aging aches or ordinary muscle strain.
The condition typically develops gradually, as the spaces within the spine narrow over time due to arthritis, thickened ligaments, or bone spurs.
The hallmark symptom is pain, numbness, or cramping in the lower back and legs that tends to worsen with standing or walking and improves with sitting or leaning forward.
Many patients describe a pattern where they can walk comfortably for a short distance, then need to stop and rest before continuing, sometimes referred to as neurogenic claudication.
Some patients also notice weakness in the legs, a feeling of heaviness, or tingling that radiates down toward the feet.
Because these symptoms often build slowly, it is common for patients to adjust their lifestyle around the pain rather than seek treatment right away.
They may stop taking long walks, avoid standing in line, or lean on shopping carts for support without fully recognizing how much their daily life has narrowed around managing the discomfort.
A proper diagnosis typically involves a physical examination along with imaging, such as an MRI or CT scan, to confirm the narrowing of the spinal canal and rule out other potential causes of the pain.
Case volume data tracks how many MILD procedures have actually been performed across the state, broken down by both the physician performing the procedure and the facility where it took place.
This kind of data offers a window into where patients are actually going for this treatment today, and which providers have built up the deepest base of hands-on experience with it.
Looking at the state's actual case volume, two things stand out immediately.
First, MILD case volume in Delaware is not evenly spread across dozens of providers and facilities. It is concentrated among a small number of physicians and centers who have made this procedure a consistent part of their practice.
Second, within that concentrated group, one name and one practice rise clearly to the top.
At the top of Delaware's physician rankings is Dr. John Rowlands, with 85 actual MILD cases performed, representing 39.50% of the state's total MILD case volume.
That figure alone would make him the clear leader in the state. But the fuller picture is even more striking once his colleague's volume is factored in.
Dr. Rowlands practices alongside Dr. Kader at Delaware Spine & Interventional Pain, and when Dr. Kader's MILD case volume is added into the picture, the practice's combined share of the state's total MILD volume grows even further.
For comparison, the next-highest ranked individual provider in the state, outside of this practice, accounts for 26.50% of state total volume.
That means even a single physician at Delaware Spine & Interventional Pain, considered on his own, already holds close to a 13-point lead over the next closest competitor. Combined with a second physician's volume at the same practice, the gap becomes a genuine landslide.
Delaware Physician MILD Case Volume
For patients, this kind of concentration of experience matters.
A physician who has performed dozens of MILD procedures has encountered a much wider range of patient anatomy, spinal presentations, and procedural nuances than one who performs the procedure only occasionally.
While no single statistic can substitute for a personalized consultation, procedural volume is one of the more meaningful, objective signals patients can look to when trying to understand how experienced a provider actually is with a specific treatment.
Case volume by site of care tells a similar story of concentration among a handful of leading facilities.
Based on currently available data, three sites account for the large majority of tracked MILD procedure volume in the state:
Together, these three sites account for roughly 83% of the site of care volume captured in this data set, which means a relatively small number of facilities are handling the overwhelming majority of MILD procedures performed across Delaware.
As with the physician-level data, this concentration is worth noting for patients trying to decide where to seek treatment.
A facility that regularly hosts MILD procedures is more likely to have staff, imaging equipment, and post-procedure protocols that are well practiced and dialed in for this specific treatment, compared to a facility where it is performed only rarely.
It is worth pausing on why this kind of volume data is meaningful at all, rather than just an interesting statistic.
Minimally invasive procedures like MILD depend heavily on the technical skill and pattern recognition of the physician performing them.
Unlike more standardized surgical approaches, image-guided decompression requires the physician to interpret real-time imaging and make judgment calls about exactly how much tissue to remove and where, based on each patient's unique anatomy.
Physicians who perform a high volume of a specific procedure tend to develop a faster, more refined sense of these judgment calls simply through repetition.
They have seen more variations of the same underlying problem, and they have had more opportunities to refine their technique over time.
This is a well established pattern across many areas of medicine, not just spine care, and it is one of the reasons volume and outcomes are often discussed together in clinical literature, even though volume alone does not guarantee any particular result for any individual patient.
For a Delaware patient weighing treatment options for lumbar spinal stenosis, this context can be genuinely useful.
Knowing that a provider has performed dozens of MILD procedures, rather than a handful, offers a data point that is easy to understand and easy to verify, even before a first consultation.
Delaware Spine & Interventional Pain has built its practice around offering patients access to non-opioid, minimally invasive treatment options for chronic pain, with MILD representing one part of a broader range of interventional pain services.
The practice serves patients across multiple Delaware communities, with the goal of making advanced, evidence-based pain care accessible regardless of which part of the state a patient calls home.
The case volume data outlined above reflects what that focus has produced in practice.
Rather than treating MILD as one option among many that a provider offers occasionally, Delaware Spine & Interventional Pain's physicians have made it a consistent, well practiced part of how they treat lumbar spinal stenosis, and the state's case volume numbers show the result of that focus.
If you or a loved one has been diagnosed with lumbar spinal stenosis and has been told that MILD may be an option, the provider and facility you choose can make a real difference in your experience and your comfort level going into the procedure.
Asking a potential provider directly how many MILD procedures they have performed is a reasonable, straightforward question, and one that Delaware's case volume data suggests is worth asking, given how concentrated this specific expertise is within the state.
Patients dealing with chronic lower back pain from spinal stenosis do not have to choose between doing nothing and undergoing major spine surgery.
MILD offers a middle path that has already helped many patients regain mobility and get back to daily activities they had been avoiding because of pain.
Delaware's leading MILD providers have built substantial experience with this procedure specifically, and that experience is reflected clearly in the state's actual case volume numbers.
No. MILD is performed through a small portal rather than an open incision, does not require spinal implants, and is typically done on an outpatient basis without general anesthesia. It is generally considered a much less invasive alternative to traditional spine surgery.
Many patients resume light activity within a day or two, though a physician will provide specific guidance based on the individual case. Because the procedure avoids large incisions and implants, recovery is generally shorter than what patients experience after open spine surgery.
Candidacy depends on factors such as the location and severity of the spinal stenosis, overall health, and prior treatment history. A consultation with a physician experienced in the procedure, supported by imaging such as an MRI, is the only reliable way to determine whether MILD is an appropriate option.
As with many specialized, image-guided procedures, physicians who perform a higher volume of a specific treatment tend to develop deeper familiarity with the technique and the range of anatomy they may encounter.
Case volume is not a guarantee of any particular outcome, but it is a straightforward, verifiable data point patients can use as part of a broader conversation with their provider.
Chronic lower back pain from spinal stenosis does not have to be something you simply live with or manage indefinitely with medication.
To learn more about the MILD procedure and whether it may be a fit for your specific condition, contact Delaware Spine & Interventional Pain at 302-280-1455 or visit delawarespineandpain.com to schedule a consultation.
Case volume figures reflect data available at the time of publication. The physician stack rank reflects the top two ranked providers by state volume, and the site of care stack rank reflects the top three ranked facilities, together accounting for approximately 83% of tracked site volume. Additional providers and facilities may account for the remaining share of state volume not reflected in this article.
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