The Bonati Spine Procedures
The Bonati Spine Procedures are an adaption of the concept of arthroscopy to the lumbar, cervical and thoracic spine. Dr. Bonati has developed a procedure and designed specific instruments to correct several spinal conditions. He has introduced the use of a laser to obliterate disc tissue and assist in neural decompression. Thorough continuous evolution, The Bonati Spine Procedures have been perfected to meet the needs of the patients in terms of their specific pathological conditions in the cervical, thoracic and lumbar areas of the spine. This includes discectomies, annulorrhapies, foramenostomies, arthroscopic laser arthrodesis, partial facetectomy, ligamentum flavum resection and SI joint laser debridement.
The Bonati Spine Procedures allows for a percutaneous entry, or entry through a small portal measuring only 3mm to 5mm in diameter. Only conscious IV sedation/ local anesthesia is required, thus eliminating the need for regional or general anesthesia and its inherent risks. The patient is awake, aware and alert throughout the procedure, which allows him the ability to communicate directly with the surgeon. This is extremely valuable in guiding the surgeon to the location of the pain while providing immediate feedback when pain is experienced or relieved.
Depending upon the procedure, a central or lateral approach can be utilized. This provides passage of the instrumentation to the necessary level of pathology, allowing access not only to discs, but also the vertebral body, intervertebral foramen, hypertrophic degenerative facet joint, posterior lamina, ligamentum flavum and spinous processes in order to treat multiple ligamentous problems, as well as primary joint disease. These tools are guided to their site of pathology by the use of image intensifiers. This allows the surgeon to precisely approach the site of maximum pathology. Once the instrument has reached the site, it is then docked on the site and direct visualization can take place through a series of graduated cannules. This procedure allows for direct visualization of the site and direct instrumentation of the site of pathologic control by using traditional arthroscopic surgical instrumentation, which is projected on a TV monitor. Once the site has been verified, a number of surgical techniques can be employed to affect the site. This includes application of a laser; the use of mechanical hand tools; the use of mechanical high-powered burrs and rasps. The laser that is employed is a 2.1 Holmium YAG Laser and remains today the most effective laser in orthopaedic surgery and specifically in arthroscopic surgery.
The use of The Bonati Spine Procedures enables the surgeon to remove pathologic discs, bone spurs, reduce impingement upon nerve roots by bony pathology of the posterior facet joints and allows for re-channeling the intervertebral foramen, thereby reducing nerve root impingement. It also allows for reduction or excision of hypertropic ligamentum mucosum and also the removal of impinging facet joints within the spinal canal, as well as the release and/or removal of inflamed ligamentous tissue at the sites of spinous processes of the spine and posterior joints.
(This information is a summary provided by the Orthopaedic Surgeons on staff at The Bonati Spine Institute
On October 6, 1994, the Florida Board of Medicine issued the following decision regarding the surgical procedures and medical treatment performed by Dr. Alfred O. Bonati. Its decision stated:
“These procedures are a logical extension / evolution of techniques that are already in use…logical extensions of and new uses for established procedures and are not experimental…They are being done in various places throughout the world, including the United States, and insurance companies have, in the past, paid for these procedures.”
