1. Symptoms of Spinal Stenosis. Patients usually develop back pain, leg pain and numbness with lumbar spinal stenosis. Their pain often intensifies when they are standing or walking, so these patients find it difficult to walk for long distances. When they do walk, they will frequently bend forward, which opens the spine slightly, and may relieve some of the symptoms. “Patients might have other reasons for their back or leg problems, so they’ll need to visit their physician and undergo tests to find the correct diagnosis,” says Dr. Moffatt. “Over time, these patients become less physical because of the stenosis, and because of this de-conditioning also suffer from additional pain and disability. It’s a vicious cycle.”
2. Making the diagnosis. Spine specialists typically order a magnetic resonance imaging (MRI) scan of the spine to accurately diagnose the stenosis. “An MRI will show the amount of space for the nerves, which is an indicator for stenosis,” says Dr. Moffatt. “The symptoms come from a narrowness of the spinal canal. The nerve roots don’t have enough room and suffer from compression.” Surgeons can identify whether there is a bulging disc, overgrown facet joint or compression from thickened ligaments in the spine, all reasons for stenosis, by reviewing the MRI. Surgeons may also order a CAT scan, but an MRI is the accepted gold standard.
3. Conservative treatment. Before visiting a surgeon, patients usually undergo conservative treatment such as over-the-counter medication, which can work well for a period of time. When the medication fails, physicians will order the test for a diagnosis and recommend other conservative treatments, which may include physical therapy or an epidural steroid injection. “Injections do work, but they are usually temporary. When the condition worsens, that’s when surgical considerations are discussed,” says Dr. Moffatt.
4. Surgical intervention. Most spine surgeons perform an extensive laminectomy necessitating a spinal fusion procedure. They un-roof the spine by removing the lamina on both sides of the spine to give the nerves extra room and then fuse the spine. However, Dr. Moffatt
referenced studies showing that an extensive laminectomy requiring fusion is usually unnecessary. Some surgeons also place a spacer intradiscally to maintain the foraminal space so the nerves have a few more millimeters of room.
“Rather than performing these surgeries, The Bonati Spine Institute has a patented method to address spinal stenosis that does not require fusion or the use of a spacer,” he says.
5. Advantages of minimally invasive surgery. “We put small tube in the side of the spine, remove part of the lamina, joint, thickened ligament and a small portion of the disc to open up the spine just where it is needed. This procedure leaves most of the spine intact,” he says. The minimal disruption of the patient’s anatomy provides many benefits to patients, including allowing them to heal and rehabilitate quicker.
“The amount of scar tissue is lessened when you perform the Bonati patented procedure, and there is no loss of flexibility, as there is after fusions,” says Dr. Moffatt. “Those considering surgery should remember that when one level is fused, stress is placed on other levels – which can lead to further degeneration, and therefore, more fusions.”
Another advantage of the procedures performed at The Bonati Spine Institute is the conscious sedation that allows surgeons to perform the procedure on awake patients on an outpatient basis. During the surgery, patients are able to watch the surgery unfold along with the surgeon. “Most patients are a little nervous, but as the surgery unfolds, they are put at ease by the staff and are interested in what they are seeing on the video monitor,” says Dr. Moffatt. “They forget that it’s them being operated on.”
While it is possible to find spine surgery centers that are trying to imitate the minimally invasive laser spine surgeries that Dr. Bonati pioneered, surgeries that actually employ his patented methods and instruments are performed only at The Bonati Spine Institute, he says.
Lear more about The Bonati Spine Institute.
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