The Bonati Procedures

The Bonati Procedures are an adaption of the concept of arthroscopy to lumbar spine surgery.

Dr. Alfred O. Bonati, founder of The Bonati Spine Institute, developed this minimally invasive spine surgery procedure and designed specific instruments to correct several cervical and lumbar spinal conditions. He introduced the use of a laser to remove intervertebral disc tissue during back surgery and assist in neural decompression.


Thorough continuous evolution, The Bonati 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 Procedures allow for a percutaneous entry, or entry through a small portal in the back or neck that measures only 3mm to 5mm in diameter. Only local anesthesia is required, thus eliminating the need for regional or general anesthesia and its inherent risks. The patient is awake and alert throughout the procedure, which allows him or her to communicate directly with the surgeon. This is extremely valuable in helping the surgeon pinpoint 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 used. This provides passage for the instrumentation to the necessary level of pathology in the spine, 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.

The 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 in the site 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 the 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 which remains today the most effective laser in orthopaedic surgery and specifically in arthroscopic and endoscopic surgery.

The use of The Bonati Procedure 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.

The Bonati Procedures are best defined as minimally invasive spine surgery, although these procedures are also very often defined as laser surgery, arthroscopic back surgery, arthroscopic spinal surgery, endoscopic spine surgery, advanced spine surgery, outpatient back surgery, microscopic spinal surgery, microscopic spine surgery, laser spinal surgery, spinal stenosis surgery, alternative spinal surgery, microsurgery, arthroscopic back surgery, and endoscopic back surgery.

The Bonati Procedures encompass an array of specific surgical techniques, including microdiscectomy, cervical discectomy, lumbar discectomy, thoracic discectomy, pinched nerve, microdiscectomy, laser spine surgery, laser discectomy, laminotomy, foraminoplasty, hemilaminotomy, endoscopic laminoforaminoplasty, facet debridement, endoscopic laminoforaminoplasty, discectomy of the lumbar spine, lumbar facet debridement, laser foramenoplasty of the lumbar spine, laser debridement of the lumbar spinous process, arthroscopic laser cervical discectomy-anterior approach, laser cervical decompression-posterior approach, and arthroscopic laser spinous process release.

The Bonati Procedures have shown to be effective in treating pain from sciatica, spinal fusion, headache, pinched nerve, back pain, neck pain, degenerative disc disease, sciatica, spinal instability, lumbar arthritis, degenerative disc disease, spondylosis, spondylolisthesis, failed back surgery syndrome, chronic back pain, radiculopathy, fibrosis, nerve pain, lumbar pain, cervical pain, facet syndrome, bone spurs, bulging discs, cervical disc problems, degenerative arthritis, foraminal narrowing, failed fusion, radiculitis, scar tissue, scoliosis and spinal cord compression.