APP Guidance

Identifying and educating mild^® patients

Publish date: March 2, 2026

Does your practice offer the mild^® procedure? Do you manage patient identification and education? Consider following these 3 steps to optimize your practice routine:
 

1. Start with the symptoms

ID shopping cart syndrome
Shopping Cart Syndrome – lumbar spinal stenosis (LSS) with neurogenic claudication (NC). These patients will often be the first ones to find chairs in your waiting room or use the walking aids, such as a shopping cart, to establish a flexed position. The flexed posture is a common sign of NC because it opens up the spinal canal to alleviate the pressure on the central canal to avoid pain that comes with being straight, upright, or mobile.¹

LSS with NC patients may present with limited mobility from the onset of symptoms. Patients commonly report pain and may have functional limitations. The functional limitations can include a desire to walk the dog, get the mail, and play with their grandchildren.

2. Possible signs and symptoms of a typical mild^® patient

Look for the ligament
Hypertrophic ligamentum flavum (HLF) contributes up to 85% of spinal canal narrowing²

Typical patient presentation:

• LSS at levels L1-S1 
• Hypertrophic ligamentum flavum (HLF) ≥ 2.5mm is the starting point*

*mild device kit Instructions For Use - PRT-00695 Rev C

Need additional help establishing comfort with imaging review?

• View the CME course on reading MRIs hosted by Advanced Practice Providers (APPs) Ashley Comer, NP-C; Christine Christensen, MSN, APRN; and Zohra Hussaini, MSN, FNP-BC, MBA, APRN 
• Contact your Stryker representative to set up an onsite or virtual educational session 

If HLF is present, confirm candidacy—even in patients with comorbidities. mild^® may be an option for a broad spectrum of patients.

Candidates should have:^†

• LSS at levels L1-S1 
• Hypertrophic ligamentum flavum 

Candidates may have:^†

• Medical comorbidities 
  • Osteoporosis, BMI >40 
• Spinal comorbidities 
  • Grade 1–2 spondylolisthesis, foraminal narrowing, degenerative disc disease, lateral recess narrowing 

^†Please refer to the IFU for a full list of indications, contraindication, warnings, and precautions

Confirm coverage
mild^® is covered nationwide by Medicare and Medicare Advantage. Commercial coverage and other plans vary.^{††
††}Patients treated with mild under Medicare and Medicare Advantage are required to be entered into a Medicare claims-based study. All claims processed through Medicare programs must include the appropriate National Clinical Trial number (NCT).³

3. Educate patients & establish appropriate outcomes and expectations

Educate early – move to mild^® after the first ESI fails⁴

Establish appropriate outcomes and expectations

Significant functional improvement⁷

Postoperative patient management

• At-home reconditioning walking program can be initiated immediately, as tolerated 
• Assess outcomes at 2-weeks and 4-6 weeks, then monthly. Assess mobility and Quality of Life (QOL) improvements, such as: 
  • Transfer ability: Getting in and out of the bed/seat/car 
  • Walking and standing times 
  • Activities of daily living: Ability to get dressed, take off shoes, household chores, and grocery shopping

If you would like a mild^® Quick Reference Card for your office or to learn more about APP-specific educational opportunities, please contact your local sales representative.

Key Resources