Study of Epidural Steroid Injection (ESI) Versus Minimally Invasive Lumbar Decompression (Mild®) in Patients With Symptomatic Lumbar Central Canal Stenosis

Inclusion Criteria: * Symptomatic Lumbar Spinal Stenosis (LSS) primarily caused by dorsal element hypertrophy. * Prior failure of conservative therapy and ODI Score \>20%. * Radiologic evidence of LSS (L3-L5), Ligamentum flavum \>2.5mm, confirmed by pre-op MRI and/or CT. * Central canal cross sectional area ≤ 100 square mm. * Anterior listhesis ≤ 5.0mm. * Able to walk at least 10 feet unaided before being limited by pain. * Available to complete 26 weeks of follow-up. * A signed Informed Consent Form is obtained from the patient. * Adults at least 18 years of age. Exclusion Criteria: * Prior surgery at intended treatment level. * History of recent spinal fractures with concurrent pain symptoms. * Disabling back or leg pain from causes other than LSS (e.g. acute compression fracture, metabolic neuropathy, or vascular claudication symptoms, etc.) * Significant / symptomatic disc protrusion or osteophyte formation. * Excessive / symptomatic facet hypertrophy. * Bleeding disorders and/or current use of anti-coagulants. * Use of ASA and/or NSAID within 5 days of treatment. * Pregnant and/or breastfeeding. * Epidural steroids previously administered (not ESI naive) * Wound healing pathologies deemed to compromise outcomes, including: diabetes, excessive smoking history, cancer, connective tissue diseases, recent spine radiation and severe COPD. * Dementia and/or inability to give informed consent. * Inability of the patient to lie prone for any reason with anesthesia support (e.…