The Bonati Spine Institute in Hudson, Florida, has published a set of questions for patients with chronic back and neck pain to ask before any spinal operation. The release coincides with Pain Awareness Month, observed in the United States each September.
Dr. Alfred Bonati, founder and chief orthopedic surgeon of the institute, said many patients have not received a direct answer about the source of their pain.
“Most of the people who come to us have been in pain for years, and most of them have been treated for years,” Bonati said. “Many of them have never gotten a straight answer to one basic question: what specifically is generating this pain, and how do you know? With September being Pain Awareness Month, we feel it’s beyond a reasonable time to ask it.”
Fusion outcomes and repeat surgeries#
Much of the guidance concerns spinal fusion, a common operation for degenerative spine conditions. For common degenerative reasons such as degenerative spondylolisthesis and lumbar stenosis, several major randomized trials comparing fusion with decompression alone found no meaningful difference in patient-reported outcomes. A five-year follow-up published in 2024 reported that patients who were not fused had better quality of life than those who were.
Fusion also carries a documented pattern of further required surgeries. Between 5% and 15% of fusions never achieve solid bone union, and a substantial share of fusion patients undergo an additional operation at an adjacent level within a decade, as the vertebrae above and below are forced to take on the work that the fused vertebrae used to perform.
Opioid use after surgery#
September is also recognized as National Recovery Month. One retrospective study of 260 fusion patients found that 44.2% were still taking opioids 90 days after surgery.
“These are serious concerns for the patient, concerns which are not often discussed prior to performing a significant procedure like a fusion surgery,” Bonati said. “For some patients, a fusion may be the correct procedure, however, these issues should absolutely be a part of the informational process before any surgical decision is reached. For a lot of the people I meet, they were not properly informed of the risks.”
The institute said patients should be skeptical of any practice that cannot answer the question of what specifically is generating the pain. The Bonati Spine Institute declines patients whose conditions fall outside what its outpatient approach can address.
Institute background#
The institute performs the Bonati Spine Procedures in Hudson, Florida, using small incisions and local anesthesia, with patients leaving the same day. It also treats patients who have had prior spine surgery, including removal of previously placed hardware and treatment of failed back surgery syndrome. Imaging is read by a fellowship-trained neuroradiologist whose training includes Weill Cornell and Memorial Sloan Kettering.
The Bonati Spine Institute is a minimally invasive spine surgery center at 7315 Hudson Ave., Hudson, Florida, in the Tampa Bay area, founded in 1984 by Dr. Alfred O. Bonati. Its clinical team includes board-certified neurosurgery, anesthesiology and diagnostic radiology specialists. The institute performs outpatient cervical, thoracic and lumbar decompression procedures using patented instrumentation and techniques developed over more than 42 years for:
- herniated disc
- spinal stenosis
- sciatica
- radiculopathy
- spondylolisthesis
- degenerative disc disease
- failed back surgery syndrome
Patients travel to the Hudson facility from across the United States and internationally, and 65% arrive with a history of prior failed back surgery. Contact: 855-267-0482, bonati.com.
