The institute’s push focuses on spinal fusion, a common treatment for degenerative conditions like lumbar stenosis and spondylolisthesis. Despite its prevalence, major randomized trials—including a 2024 study in The Bone & Joint Journal—have found that decompression alone often yields better quality-of-life outcomes than fusion. Beyond the lack of clear benefit, fusion surgery carries long-term risks, such as the potential for adjacent-level failure and a reliance on opioids during recovery. One study of 260 fusion patients found that over 44% remained on opioid medication 90 days post-operation.
Asking the right questions before spinal surgery
As Pain Awareness Month begins, the Bonati Spine Institute is urging patients to challenge surgeons on the necessity of invasive procedures. Founder Dr. Alfred Bonati argues that many patients endure years of chronic discomfort without ever receiving a clear, evidence-based explanation of what is actually generating their pain.
Dr. Bonati contends that patients are frequently left in the dark regarding these risks, prompting the institute to release a list of essential questions for surgical consultations. Patients are advised to demand specific diagnostic evidence, inquire about the surgeon’s training in reading imaging, and explicitly ask what would disqualify them as a candidate for a proposed procedure. According to the institute, any practice unable to identify a patient as a poor candidate for a specific surgery should be viewed with skepticism.
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