Tuesday, February 24, 2009
Wojtek's Blog
Wojtek Trzebaniak is a Canadian Olympic hopeful in the bobsled. He recently visited The Bonati Institute from Calgary, Alberta, Canada for treatment of a lower back condition which could have ended his dream for Olympic gold. While at The Bonati Institute Wojtek maintained a blog as a daily diary of his experiences. You can share Wojtek's experience by clicking oh this link to his bloga
Thursday, September 4, 2008
Bonati Facts
"Great innovators and original thinkers and artists attract the wrath of mediocrities as lightning rods draw the flashes."
Theodor Reik
Dr. Alfred O. Bonati developed and perfected advanced endoscopic laser spine surgery more than 25 years ago. As a pioneer in the field of advanced endoscopic laser spine surgery, Dr. Bonati has experienced some misunderstanding and some resistance from the medical community and the insurance industry. The purpose of Bonati Facts is to educate the public as to the truth, and to put an end to some of the rumors that have circulated from time to time about Dr. Bonati, The Bonati Institute and The Bonati Procedure.
The Bonati Institute® has operated continuously for over 20 years, and has never experienced a suspension or interruption of any of its licenses or accreditations.
The Bonati Institute and Dr. Bonati have not, and have never been, restricted from performing surgery.
The Bonati Institute and Dr. Bonati have never had a legal judgment entered against them.
Dr. Bonati holds six U.S. Patents on The Bonati Procedures, which include instrumentation and methods for advanced endoscopic laser spine surgery.
The Bonati Institute and Dr. Bonati were instrumental in gaining FDA approval of the Holmium YAG Laser for spine surgery.
The Bonati Procedures are performed only at The Bonati Institute in Hudson, Florida and only by surgeons authorized by Dr. Bonati.
Over these past 25 years Dr. Bonati and the surgeons of The Bonati Institute have performed more than 35,000 successful procedures without causing a fatality, disability or major infection.
Theodor Reik
Dr. Alfred O. Bonati developed and perfected advanced endoscopic laser spine surgery more than 25 years ago. As a pioneer in the field of advanced endoscopic laser spine surgery, Dr. Bonati has experienced some misunderstanding and some resistance from the medical community and the insurance industry. The purpose of Bonati Facts is to educate the public as to the truth, and to put an end to some of the rumors that have circulated from time to time about Dr. Bonati, The Bonati Institute and The Bonati Procedure.
The Bonati Institute® has operated continuously for over 20 years, and has never experienced a suspension or interruption of any of its licenses or accreditations.
The Bonati Institute and Dr. Bonati have not, and have never been, restricted from performing surgery.
The Bonati Institute and Dr. Bonati have never had a legal judgment entered against them.
Dr. Bonati holds six U.S. Patents on The Bonati Procedures, which include instrumentation and methods for advanced endoscopic laser spine surgery.
The Bonati Institute and Dr. Bonati were instrumental in gaining FDA approval of the Holmium YAG Laser for spine surgery.
The Bonati Procedures are performed only at The Bonati Institute in Hudson, Florida and only by surgeons authorized by Dr. Bonati.
Over these past 25 years Dr. Bonati and the surgeons of The Bonati Institute have performed more than 35,000 successful procedures without causing a fatality, disability or major infection.
Tuesday, August 19, 2008
Symptoms of Spinal Stenosis
The various types of spinal stenosis produce very similar symptoms. In general, chronic pain with limitations on mobility are the most common symptoms associated with spinal stenosis. Pressure on the lower, or lumbar, part of the spinal cord or on nerve roots branching out from the lower back area may give rise to pain or numbness in the legs. Pressure on the upper, or cervical, part of the spinal cord (the neck area) may produce similar symptoms in the shoulders and arms.
The symptoms of spinal stenosis usually develop slowly over time and occur during certain activities or when the body assumes certain positions. The pain may come and go, as opposed to being continuous, and, at times may be relieved by lying down or sitting in a flexed forward position. This flexed position "opens up" the spinal column, enlarging the spaces between vertebrae at the back of the spine.
Pain in the legs when walking is a common symptom of lumbar spinal stenosis. Although occasionally this leg pain from spinal stenosis comes on acutely, it usually develops over several years. Numbness and tingling can accompany pain from lumbar spinal stenosis.
Pseudoclaudication is pain and discomfort in the buttocks, legs and feet due to narrowing of the spinal canal from spinal stenosis. In pseudoclaudication, the narrowing of the spinal canal compresses the nerves that control movement and sensation in the legs. It may also cause numbness and weakness in the legs.
People with more severe spinal stenosis may also experience abnormal bowel and bladder function and foot disorders. For example, cauda equina syndrome is a partial or complete loss of control of the bowel or bladder and sometimes sexual function.
The collection of nerves at the end of the spinal cord is known as the cauda equina, due to its resemblance to a horse's tail. The spinal cord ends at the upper portion of the lumbar (lower back) spine. The individual nerve roots at the end of the spinal cord that provide motor and sensory function to the legs and the bladder continue along in the spinal canal. The cauda equina is the continuation of these nerve roots in the lumbar region. These nerves send and receive messages to and from the lower limbs and pelvic organs.
Caudia equina syndrome most commonly results from a massive herniated disc in the lumbar region. A single excessive strain or injury may cause a herniated disc. However, disc material also degenerates naturally with age, and the ligaments that hold the discs in place begin to weaken. As this degeneration progresses, a relatively minor strain or twisting movement can cause a disc to rupture.
For more information: www.bonati.com/glossary/spinal_stenosis.html
The symptoms of spinal stenosis usually develop slowly over time and occur during certain activities or when the body assumes certain positions. The pain may come and go, as opposed to being continuous, and, at times may be relieved by lying down or sitting in a flexed forward position. This flexed position "opens up" the spinal column, enlarging the spaces between vertebrae at the back of the spine.
Pain in the legs when walking is a common symptom of lumbar spinal stenosis. Although occasionally this leg pain from spinal stenosis comes on acutely, it usually develops over several years. Numbness and tingling can accompany pain from lumbar spinal stenosis.
Pseudoclaudication is pain and discomfort in the buttocks, legs and feet due to narrowing of the spinal canal from spinal stenosis. In pseudoclaudication, the narrowing of the spinal canal compresses the nerves that control movement and sensation in the legs. It may also cause numbness and weakness in the legs.
People with more severe spinal stenosis may also experience abnormal bowel and bladder function and foot disorders. For example, cauda equina syndrome is a partial or complete loss of control of the bowel or bladder and sometimes sexual function.
The collection of nerves at the end of the spinal cord is known as the cauda equina, due to its resemblance to a horse's tail. The spinal cord ends at the upper portion of the lumbar (lower back) spine. The individual nerve roots at the end of the spinal cord that provide motor and sensory function to the legs and the bladder continue along in the spinal canal. The cauda equina is the continuation of these nerve roots in the lumbar region. These nerves send and receive messages to and from the lower limbs and pelvic organs.
Caudia equina syndrome most commonly results from a massive herniated disc in the lumbar region. A single excessive strain or injury may cause a herniated disc. However, disc material also degenerates naturally with age, and the ligaments that hold the discs in place begin to weaken. As this degeneration progresses, a relatively minor strain or twisting movement can cause a disc to rupture.
For more information: www.bonati.com/glossary/spinal_stenosis.html
Wednesday, August 6, 2008
Research and Outreach
Back neck problems are the number reason people seek medical attention, miss work, and file for disability. There are also more than 100 different symptoms that can result from a problem with the lumbar or cervical spine. For most people these symptoms are short-lived and acute. For others the symptoms may last for more than 3 months, classifying them as chronic pain.
Over the past 25 years we at The Bonati Institute have come to realize that there are two very important steps that anyone seeking medical attention for chronic pain from a lumbar or cervical spine problem should take. The first is research. There are dozens, if not hundreds, of treatment methods for spine prblems. They range from very conservative and non-invasive protocols like physical therapy and medication, to more aggressive invasive protocols like surgery.
One can imagine these many treatment options as existing along a continuum, with conservative non-invasive treatment being appropriate for persons whose onset of chronic pain is recent, and the more agressive and invasive treatments as being appropriate for persons whose onset of pain is further in the past.
Which treatment is best for your level of pain is partially in your hands. In this respect the internet has been a boon to "patient-directed" treatment, and presently to seek health information is the number one reason that people search on the net. Given that, we believe that it is critical that patients conduct as much research as possible on the Internet before seeking medical attention.
The second part to this is outreach. With any surgery, there is more to the protocl than just the "cutting". Any surgery or major medical procedure is only as effective as the array of services associated with it. Since the pre-operative and post-operative experience can be just as important as the surgical experience, we also encourage that you take the time to reach out to patients who have had the treatment for a "first-hand" impression.
Over the past 25 years we at The Bonati Institute have come to realize that there are two very important steps that anyone seeking medical attention for chronic pain from a lumbar or cervical spine problem should take. The first is research. There are dozens, if not hundreds, of treatment methods for spine prblems. They range from very conservative and non-invasive protocols like physical therapy and medication, to more aggressive invasive protocols like surgery.
One can imagine these many treatment options as existing along a continuum, with conservative non-invasive treatment being appropriate for persons whose onset of chronic pain is recent, and the more agressive and invasive treatments as being appropriate for persons whose onset of pain is further in the past.
Which treatment is best for your level of pain is partially in your hands. In this respect the internet has been a boon to "patient-directed" treatment, and presently to seek health information is the number one reason that people search on the net. Given that, we believe that it is critical that patients conduct as much research as possible on the Internet before seeking medical attention.
The second part to this is outreach. With any surgery, there is more to the protocl than just the "cutting". Any surgery or major medical procedure is only as effective as the array of services associated with it. Since the pre-operative and post-operative experience can be just as important as the surgical experience, we also encourage that you take the time to reach out to patients who have had the treatment for a "first-hand" impression.
Wednesday, July 16, 2008
Causes of Spinal Stenosis
Spinal stenosis is the narrowing of the spinal canal, and it can be present at any level of the spine. While lumbar spinal stenosis is the most common type, stenosis can also occur in the thoracic or cervical areas of the spine. Spinal stenosis causes a variety of symptoms such as severe pain, weakness, numbness and the loss of mobility.
Spinal stenosis is often associated with the aging process, as when ligaments begin to calcify and bone spurs form. These abnormalities can intrude into the spinal canal and cause pressure on the nerve roots by limiting the amount of space in the spinal column. This nerve compression often causes pain, tingling, or numbness in the extremities.
Spinal stenosis can be congenital (i.e. a birth defect). With congenital spinal stenosis, the patient is born with a narrow spinal canal due to abnormally formed parts of the spine. This condition is most common in patients with a short stature, such as achondroplastic dwarves. Spinal stenosis may also result from any of the following non-congenital conditions:
Aging
Osteoarthritis
Osteoarthritis is a form of arthritis typically caused by age-related wear-and-tear, and is the most common form of arthritis. Sometimes osteoarthritis follows an injury to a joint. For example, a young person might hurt his knee badly playing soccer. Then, years after the knee has apparently healed, he might get arthritis in his knee joint.
Rheumatoid arthritis
Rheumatoid arthritis is an inflammatory disease that causes pain, swelling, stiffness, and loss of function in the joints. It occurs in a symmetrical pattern, meaning that if one joint is affected, the corresponding joint is also affected. People with rheumatoid arthritis often experience fatigue, occasional fever, and a general sense of malaise.
Spondylosis
Spondylosis is a degeneration of the vertebral functions leading to the formation of bones spurs. Spondylosis commonly occurs with aging. Often there is an accompanying herniation of an intervertebral disc and compression of nerve roots. This compression can result in sensory and motor disturbances and pain.
Spondylolisthesis
Spondylolisthesis is a condition that occurs when one vertebra slips forward over another vertebra.
Spinal injury
Spinal birth defect
Spinal tumors
Swelling after spinal surgery
Paget's Disease of Bone
Paget's Disease is a disease of the bones usually occurring in middle-aged and elderly patients. Paget’s Disease initially results in the excessive destruction of the bone followed by the replacement of normal bone marrow with vascular and fibrous tissue. This excessive bone destruction sometimes leads to bone pain and fractures. When any disease reaches the point of causing nerve root inflammation or irritation, the results can become intolerable.
For more information: www.bonati.com/glossary/spinal_stenosis.html
Spinal stenosis is often associated with the aging process, as when ligaments begin to calcify and bone spurs form. These abnormalities can intrude into the spinal canal and cause pressure on the nerve roots by limiting the amount of space in the spinal column. This nerve compression often causes pain, tingling, or numbness in the extremities.
Spinal stenosis can be congenital (i.e. a birth defect). With congenital spinal stenosis, the patient is born with a narrow spinal canal due to abnormally formed parts of the spine. This condition is most common in patients with a short stature, such as achondroplastic dwarves. Spinal stenosis may also result from any of the following non-congenital conditions:
Aging
Osteoarthritis
Osteoarthritis is a form of arthritis typically caused by age-related wear-and-tear, and is the most common form of arthritis. Sometimes osteoarthritis follows an injury to a joint. For example, a young person might hurt his knee badly playing soccer. Then, years after the knee has apparently healed, he might get arthritis in his knee joint.
Rheumatoid arthritis
Rheumatoid arthritis is an inflammatory disease that causes pain, swelling, stiffness, and loss of function in the joints. It occurs in a symmetrical pattern, meaning that if one joint is affected, the corresponding joint is also affected. People with rheumatoid arthritis often experience fatigue, occasional fever, and a general sense of malaise.
Spondylosis
Spondylosis is a degeneration of the vertebral functions leading to the formation of bones spurs. Spondylosis commonly occurs with aging. Often there is an accompanying herniation of an intervertebral disc and compression of nerve roots. This compression can result in sensory and motor disturbances and pain.
Spondylolisthesis
Spondylolisthesis is a condition that occurs when one vertebra slips forward over another vertebra.
Spinal injury
Spinal birth defect
Spinal tumors
Swelling after spinal surgery
Paget's Disease of Bone
Paget's Disease is a disease of the bones usually occurring in middle-aged and elderly patients. Paget’s Disease initially results in the excessive destruction of the bone followed by the replacement of normal bone marrow with vascular and fibrous tissue. This excessive bone destruction sometimes leads to bone pain and fractures. When any disease reaches the point of causing nerve root inflammation or irritation, the results can become intolerable.
For more information: www.bonati.com/glossary/spinal_stenosis.html
Thursday, July 10, 2008
What Is Spinal Stenosis?
Spinal stenosis is a narrowing of the space called the spinal canal, a small space in the backbone that contains the spinal cord and the sensory and motor nerve roots that run from the brain and out from the spinal cord to all parts of the body. The spinal canal is like a tunnel which runs up and down the human spine. This canal sits directly behind the bone blocks which make up the spine (vertebrae).
A normal spinal canal tunnel contains some free space between the important neurologic (nerve) structures it houses, such as the spinal cord and the nerve roots and the edges of the spinal canal. The canal is surrounded by bone and ligaments and therefore cannot expand if the spinal cord or nerves require more room. Therefore, if anything begins to narrow the spinal canal, there is risk for irritation or injury of the spinal cord or nerves. The spine may become narrowed in any of three areas: in the space at the center of the spine, in the canals where nerves branch out from the spine, and in the space between the bones of the spine (vertebrae).
When an abnormality causes a narrowing of a canal then the neurologic (nerve) structures within that canal can become irritated or compressed. This can lead to a variety of symptoms ranging from tingling, numbness, and weakness to severe pain and paralysis. The most common conditions which can narrow a spinal canal and cause stenosis include herniated discs (often called slipped discs), a fracture of the spine, tumors, infection and degeneration through the aging process.
Stenosis can occur anywhere along the spine but most commonly occurs in the lower spine (lumbar) region. Lumbar spinal stenosis can cause nerve compression which leads to persistent pain in the buttocks, limping, lack of feeling in the lower extremities, and decreased physical activity. Additional symptoms from lumbar spinal stenosis include sensations of heaviness, weakness and pain with walking or prolonged standing. There are several different forms of lumbar spinal stenosis.
The most common form of lumbar spinal stenosis is degenerative stenosis, which occurs to some degree in virtually the entire adult population as a result of the natural process of aging. This form of stenosis is a degenerative narrowing of the spinal canal, the nerve root canals or the intervertebral foramina caused by an unnatural enlargement (hypertrophy) of intervertebral discs, bones or ligaments. The narrowing results in compression of spinal nerves and nerve roots, causing a range of symptoms, including lower back pain, limping or impaired gait as a result of reduced blood supply to the leg muscles (neurogenic claudication) and lower extremity pain.
Congenital lumbar stenosis is relatively rare and usually appears at an early age, often between 30 and 40. The congenital form of spinal stenosis is seen in individuals who are born with a narrow spinal canal. In these individuals, even minimal changes in the structure of the spine brought on by age can cause severe spinal stenosis. Congenital spinal stenosis is largely a mysterious condition that can neither be predicted nor prevented. The onset does not distinguish by sex, race, or ethnicity, and is not associated with any particular occupation or any particular body type.
Acquired lumbar spinal stenosis is more common and generally develops in persons who are in their 60s or older. This form of stenosis is caused by progressive changes in different spinal elements (such as the discs, joints, ligaments, etc.) As people age, all these different elements sag or bulge and form arthritis that narrows the spinal canal.
Treatment for spinal stenosis ranges from physical therapy to epidural injections and finally surgery in certain cases. Arthroscopic surgery for spinal stenosis has a high success rate in patients carefully selected for this procedure. It remains a useful approach in treatment when other options have been exhausted and after careful review of risks and benefits with the patient.
A normal spinal canal tunnel contains some free space between the important neurologic (nerve) structures it houses, such as the spinal cord and the nerve roots and the edges of the spinal canal. The canal is surrounded by bone and ligaments and therefore cannot expand if the spinal cord or nerves require more room. Therefore, if anything begins to narrow the spinal canal, there is risk for irritation or injury of the spinal cord or nerves. The spine may become narrowed in any of three areas: in the space at the center of the spine, in the canals where nerves branch out from the spine, and in the space between the bones of the spine (vertebrae).
When an abnormality causes a narrowing of a canal then the neurologic (nerve) structures within that canal can become irritated or compressed. This can lead to a variety of symptoms ranging from tingling, numbness, and weakness to severe pain and paralysis. The most common conditions which can narrow a spinal canal and cause stenosis include herniated discs (often called slipped discs), a fracture of the spine, tumors, infection and degeneration through the aging process.
Stenosis can occur anywhere along the spine but most commonly occurs in the lower spine (lumbar) region. Lumbar spinal stenosis can cause nerve compression which leads to persistent pain in the buttocks, limping, lack of feeling in the lower extremities, and decreased physical activity. Additional symptoms from lumbar spinal stenosis include sensations of heaviness, weakness and pain with walking or prolonged standing. There are several different forms of lumbar spinal stenosis.
The most common form of lumbar spinal stenosis is degenerative stenosis, which occurs to some degree in virtually the entire adult population as a result of the natural process of aging. This form of stenosis is a degenerative narrowing of the spinal canal, the nerve root canals or the intervertebral foramina caused by an unnatural enlargement (hypertrophy) of intervertebral discs, bones or ligaments. The narrowing results in compression of spinal nerves and nerve roots, causing a range of symptoms, including lower back pain, limping or impaired gait as a result of reduced blood supply to the leg muscles (neurogenic claudication) and lower extremity pain.
Congenital lumbar stenosis is relatively rare and usually appears at an early age, often between 30 and 40. The congenital form of spinal stenosis is seen in individuals who are born with a narrow spinal canal. In these individuals, even minimal changes in the structure of the spine brought on by age can cause severe spinal stenosis. Congenital spinal stenosis is largely a mysterious condition that can neither be predicted nor prevented. The onset does not distinguish by sex, race, or ethnicity, and is not associated with any particular occupation or any particular body type.
Acquired lumbar spinal stenosis is more common and generally develops in persons who are in their 60s or older. This form of stenosis is caused by progressive changes in different spinal elements (such as the discs, joints, ligaments, etc.) As people age, all these different elements sag or bulge and form arthritis that narrows the spinal canal.
Treatment for spinal stenosis ranges from physical therapy to epidural injections and finally surgery in certain cases. Arthroscopic surgery for spinal stenosis has a high success rate in patients carefully selected for this procedure. It remains a useful approach in treatment when other options have been exhausted and after careful review of risks and benefits with the patient.
Tuesday, July 8, 2008
Fixing $5 Haircuts
There's an old fable about a man that had a very successful barber shop offering $10 haircuts. One day another shop opened across the street advertising "$5 haircuts". The established barber, after watching the results of his competitor, over a few days, erected a sign stating "We fix $5 haircuts".
The cautionary tale here is to analyze carefully any claims by spine surgical centers offering "minimally-invasive" spine surgery. When it comes to spine surgery it is possible to avoid "$5 haircuts" with a little prior analysis.
First, look beyond the claims of the number of surgeries "performed" to the percentage of successful surgeries, with success being defined as complete restoration of function, complete eradication of pain, and return to daily activities without impairment.
Secondly, try to gather as much information as you can on the actual mechanics of the surgery. How large is the incision? Some surgical centers, claiming that they are "minimally-invasive", actually work through incisions of four to six inches, rather than the 1/4 to 1/2 inch incision employed by true "minimally-invasive" surgical centers.
If a "minimally-invasive" surgical center claims that they can perform more than one surgery on your spine in a day or one or more surgeries only one day apart, be suspicious. "Minimally-invasive" not only applies to the size of the incision but also to the incremental nature of the surgical protocol. True minimally-invasive, advanced laser spine surgery separates each procedure by at least a week.
Lastly, look into the length of time each surgery takes. In this case, the longer the better. The full protocol for a minimally-invasive arthroscopic discectomy, for example, should take at least 1 1/2 to 2 hours. Anything less is likely to not be the full and proper protocol of a minimally-invasive arthroscopic spine procedure.
The cautionary tale here is to analyze carefully any claims by spine surgical centers offering "minimally-invasive" spine surgery. When it comes to spine surgery it is possible to avoid "$5 haircuts" with a little prior analysis.
First, look beyond the claims of the number of surgeries "performed" to the percentage of successful surgeries, with success being defined as complete restoration of function, complete eradication of pain, and return to daily activities without impairment.
Secondly, try to gather as much information as you can on the actual mechanics of the surgery. How large is the incision? Some surgical centers, claiming that they are "minimally-invasive", actually work through incisions of four to six inches, rather than the 1/4 to 1/2 inch incision employed by true "minimally-invasive" surgical centers.
If a "minimally-invasive" surgical center claims that they can perform more than one surgery on your spine in a day or one or more surgeries only one day apart, be suspicious. "Minimally-invasive" not only applies to the size of the incision but also to the incremental nature of the surgical protocol. True minimally-invasive, advanced laser spine surgery separates each procedure by at least a week.
Lastly, look into the length of time each surgery takes. In this case, the longer the better. The full protocol for a minimally-invasive arthroscopic discectomy, for example, should take at least 1 1/2 to 2 hours. Anything less is likely to not be the full and proper protocol of a minimally-invasive arthroscopic spine procedure.
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