| While no area in spinal surgery seems to exist | | | | variety of tests to look at the inside of the body. |
| without controversy, laminectomies continue to | | | | Examples of these tests include: |
| be one of the most controversial. By definition, a | | | | X-rays - these tests can show the structure of |
| laminectomy is a surgical procedure in which a | | | | the vertebrae and the outlines of joints and can |
| portion of a vertebra is removed to relieve | | | | detect calcification. |
| pressure on the spinal cord on the nerve roots | | | | MRI (magnetic resonance imaging) - this test |
| that emerge from the spinal canal. The procedure | | | | gives a three-dimensional view of parts of the |
| is often used to treat spinal stenosis, a | | | | back and can show the spinal cord, nerve roots, |
| progressive narrowing of the opening in the spinal | | | | and surrounding spaces, as well as enlargement, |
| canal. | | | | degeneration, tumors or infection. |
| According to the American Academy of | | | | Computerized axial tomography (CAT scan) - this |
| Orthopedic Surgeons, there are approximately | | | | test shows the shape and size of the spinal canal, |
| 200,000 laminectomies performed every year. An | | | | its contents and structures surrounding it. It |
| estimated 20% -30% are reported to be | | | | shows bone better than nerve tissue. |
| unsuccessful, with a reoperation rate of | | | | Myelogram - a liquid dye is injected into the spinal |
| 10%-25%. Even though these statistics include | | | | column and appears white against bone on an |
| surgeries for a wide variety of conditions in | | | | x-ray film. A myelogram can show pressure on |
| addition to stenosis, it is easy to see that the | | | | the spinal cord or nerves from herniated discs, |
| problems of "failed back surgery" are enormous. | | | | bone spurs or tumors. |
| There is nothing more distressing to the physician | | | | Bone scan - This test uses injected radioactive |
| or the patient than to be faced with this unhappy | | | | material that attaches itself to bone. A bone scan |
| dilemma. There are over l5 billion dollars spent on | | | | can detect fractures, tumors, infections, and |
| low back care every year in this country. We can | | | | arthritis, but may not tell one disorder from |
| no longer afford anything less than a good | | | | another. Therefore, a bone scan is usually |
| outcome. Can the failed back surgery syndrome | | | | performed along with other tests. |
| be avoided? What is going wrong? Why are there | | | | Treatment |
| so many failed back surgeries? Is it the patient's | | | | Mild cases of spinal stenosis may be treated with |
| fault? Is it the surgeon's fault? Or is it just the | | | | rest, nonsteroidal anti-inflammatory drugs (such as |
| natural history of the disease? There are biologic | | | | aspirin), and muscle relaxants. Spinal stenosis can |
| variables doctors cannot control such as bone | | | | be a progressive disease, however, and the |
| healing, cartilage degeneration, and patient | | | | source of pressure may have to be surgically |
| behavior, all of which can affect outcome. | | | | removed. |
| Should patients with stenosis who are | | | | Surgical Treatment |
| experiencing failed open back surgery give up? No. | | | | In many cases, non-surgical treatments do not |
| Patients with stenosis should consider the | | | | treat the conditions that cause spinal stenosis, |
| following: | | | | however they might temporarily relieve pain. |
| Diagnosis | | | | Severe cases of stenosis often require surgery. |
| The physician must determine that the | | | | The goal of the surgery is to relieve pressure on |
| symptoms are caused by spinal stenosis. | | | | the spinal cord or spinal nerve by widening the |
| Conditions that can cause similar symptoms | | | | spinal canal. This is done by removing, trimming, or |
| include a slipped (herniated) intervertebral disc, | | | | realigning involved parts that are contributing to |
| spinal tumors, and disorders of the blood flow | | | | the pressure. |
| (circulatory disorders). Spinal stenosis causes back | | | | The most common surgery in the lumbar spine to |
| and leg pain. The leg pain is usually worse when | | | | treat stenosis is the laminectomy. A surgeon may |
| the patient is standing or walking. Some forms of | | | | perform a laminectomy with or without fusing |
| spinal stenosis are less painful when the patient is | | | | vertebrae or removing part of a disc. Various |
| riding an exercise bike because the forward tilt of | | | | devices (like screws or rods) may be used to |
| the body changes the pressure in the spinal | | | | enhance fusion and support unstable areas of the |
| column. Doppler scanning can trace the flow of | | | | spine. |
| blood to determine whether the pain is caused by | | | | A laminectomy is considered open back surgery. |
| circulatory problems. X-ray images, computed | | | | Many people have endured the long recovery |
| tomography scans (CT scans), and magnetic | | | | process of such a procedure, only to learn that |
| resonance imaging (MRI) scans can reveal any | | | | the outcome is poor. Not only is this a physically |
| narrowing of the spinal canal. Electromyography, | | | | painful experience, it is also very difficult to deal |
| nerve conduction velocity, or evoked potential | | | | with emotionally. |
| studies can locate problems in the muscles | | | | With advances in science and technology, there |
| indicating areas of spinal cord compression. | | | | are alternatives. A proven alternative for helping |
| How Stenosis is Diagnosed | | | | to alleviate the pain of a failed laminectomy is The |
| Before making a diagnosis of stenosis, it is | | | | Bonati Procedures(sm). |
| important for the doctor to rule out other | | | | The Bonati Procedures are advanced spine |
| conditions that may have similar symptoms. In | | | | surgeries developed and perfected by The Bonati |
| order to do this, most doctors use a combination | | | | Institute(sm). The procedures employ the smallest |
| of tools, including: | | | | incision possible to correct problems of the |
| History: The doctor will begin by asking the patient | | | | lumbar, cervical and thoracic spine with patented |
| to describe any symptoms he or she is having | | | | instrumentation and methods. The Bonati |
| and how the symptoms have changed over time. | | | | Procedures are performed sequentially as |
| The doctor will also need to know how the | | | | outpatient surgeries with the patient under local |
| patient has been treating these symptoms | | | | anesthesia and alert and able to communicate |
| including what medications the patient has tried. | | | | with the surgeon throughout the procedure. The |
| Physical Examination: The doctor will then examine | | | | result of this approach is far less trauma to the |
| the patient by checking for any limitations of | | | | muscles and tissues, minimal blood loss and faster |
| movement in the spine, problems with balance | | | | recovery. The Bonati Procedures are performed |
| and signs of pain. The doctor will also look for any | | | | only at The Bonati Institute. |
| loss of extremity reflexes, muscle weakness, | | | | Consider all options |
| sensory loss, or abnormal reflexes which may | | | | Before you agree to undergo any back surgery, |
| suggest spinal cord involvement. | | | | consider getting a second opinion from a qualified |
| Tests | | | | spine specialist. |
| After examining the patient, the doctor can use a | | | | |