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Surgical Procedures

The Bonati Procedures for the Spine

Laser Discectomy

This procedure is designed to help people with herniated discs impinging on a nerve root causing:

• Severe back pain with radiculopathy or radiation of pain into the extremities


• Pain that has not responded to conventional treatments such as rest, analgesics, prescription pain medication, physical therapy or chiropractic manipulation after three months

The Bonati Procedures are used to decompress the nerve root and remove that portion of the disc that is causing nerve compression and pain.

Microsurgical Debridement of the Facet Joint with Rhizolysis

This procedure is designed to help people with:

• Pain from facet joint disease


• No response to conventional treatments such as rest, analgesics, prescription pain medication, physical therapy or chiropractic manipulation after three months

The facet joints allow the spine to flex, extend and rotate. The capsules of the facet contain smaller hair-sized sensitive nerves that can become irritated by inflammation caused by degenerative facet joint disease or osteoarthritis resulting in a sensation of pain.

In order to determine if the target joint is the source of the patient’s pain, the patient undergoes diagnostic injections using local anesthetics. If the pain is not relieved, the facet joint is ruled out as the source of pain. If the pain is relieved, then microsurgical debridement of the facets with rhizolysis is recommended.

Laminotomy and Foraminotomy

This procedure is designed to help people with:

• Severe back pain with radiculopathy or radiation of pain into the extremities


• No response to conventional treatments such as rest, analgesics, prescription pain medication, physical therapy or chiropractic manipulation after three months

The lamina form a roof over the neural canal. A laminotomy is the partial removal of the lamina to gain access to the affected nerve root. The foramen is the window through which a nerve root exits the spine. Bone spurs that form as a result of degenerative disc disease or spinal arthritis may narrow the foramen, causing nerve root impingement and back pain.

The Bonati Procedures are used to remove tissue from the foramen and decompress the nerve roots that are causing back pain.

Hardware Removal

This procedure is designed to help people who have had:

• Open spine surgery with hardware placement who continue to experience severe back pain with radiculopathy or radiation of pain into the extremities

Some cause of continued pain after open spine surgery can be traced to scar tissue build-up which impinges on the nerve. In some instances screw heads or other hardware may have moved and is now touching a nerve.

In 2004 Alfred O. Bonati, M.D. was awarded two patents from the United States Patent and Trademark Office for his method and specialized instruments for removing orthopaedic hardware. Since that time, The Bonati Spine Institute has helped hundreds of people who have had hardware placement and continue to have pain.