Hudson, Florida – September 07, 2026 -- The Bonati Spine Institute has published a list of questions it says chronic back and neck pain patients should ask any surgeon proposing spinal surgery, timed to September's Pain Awareness Month.
"Most of the people who come to us have been in pain for years, and most of them have been treated for years," said Dr. Alfred Bonati, founder and chief orthopedic surgeon of the institute. "Many of them have never gotten a straight answer to one basic question: what specifically is generating this pain, and how do you know?"
Studies find no clear benefit from spinal fusion over decompression alone
For common degenerative conditions such as degenerative spondylolisthesis and lumbar stenosis, several randomized trials comparing fusion to decompression alone found no meaningful difference in patient-reported outcomes. A five-year follow-up published in The Bone & Joint Journal in 2024 found patients who were not fused reported better quality of life than those who were.
Between 5% and 15% of fusions fail to achieve solid bone union
Fusion surgery carries a documented risk of repeat operations, according to the institute. A substantial share of fusion patients require an additional operation at an adjacent spinal level within a decade, as neighboring vertebrae take on the workload of the fused segment.
44.2% of fusion patients still used opioids 90 days after surgery
September is also National Recovery Month. A retrospective study of 260 fusion patients found 44.2% were still taking opioids three months post-surgery. "These are serious concerns for the patient, concerns which are not often discussed prior to performing a significant procedure like a fusion surgery," Bonati said, adding that a fusion may be correct for some patients but that risks are frequently left out of the conversation.
The institute recommends six questions before agreeing to spine surgery
The list includes: What is generating my pain, and what diagnostic test established that? Am I being offered decompression, fusion or both, and what does each accomplish? What does published evidence show for my specific diagnosis, rather than back pain generally? What is my likelihood of a second operation, and at which level? Who reads my imaging, and what is that person's training? What would make me a poor candidate for what you are proposing?
The institute said patients should be skeptical of any practice unable to answer the last question. The Bonati Spine Institute, based in Hudson, Florida, performs its proprietary outpatient Bonati Spine Procedures using small incisions and local anesthesia, with patients discharged the same day, and also treats patients who have had prior spine surgery, including hardware removal and failed back surgery syndrome. Imaging is reviewed by a fellowship-trained neuroradiologist whose training includes Weill Cornell and Memorial Sloan Kettering.