As Pain Awareness Month kicks off, the Bonati Spine Institute recommends these questions before undergoing back surgery

HUDSON, Fla., Sept. 2, 2026 /PRNewswire/ -- September is Pain Awareness Month, and the Bonati Spine Institute is marking the observance by publishing a set of questions that patients with chronic back and neck pain should ask any surgeon who proposes an operation on their spine.

"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 Bonati Spine 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? With September being Pain Awareness Month, we feel it's beyond a reasonable time to ask it."

Much of the guidance concerns spinal fusion, among the most common operations offered for degenerative spine conditions. For the common degenerative reasons people are fused, including degenerative spondylolisthesis and lumbar stenosis, several major randomized trials comparing fusion against decompression alone found no meaningful difference in patient-reported outcomes. In one five-year follow-up published in The Bone & Joint Journal in 2024, patients who were not fused reported better quality of life than those who were.

Fusion also carries a documented pattern of further required surgeries. Between 5% and 15% of fusions never achieve solid bone union, and a substantial share of fusion patients undergo an additional operation at an adjacent level within a decade, as the vertebrae above and below are forced to take on the work that the fused vertebrae used to perform.

September is also recognized as National Recovery Month. One retrospective study of 260 fusion patients found that 44.2% were still taking opioids 90 days after 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. "For some patients, a fusion may be the correct procedure, however, these issues should absolutely be a part of the informational process before any surgical decision is reached. For a lot of the people I meet, they were not properly informed of the risks."

The questions the institute recommends:

• What is generating my pain, and what diagnostic test established that?
• Am I being offered decompression, fusion or both, and what does each one accomplish?
• What does the published evidence show for my specific diagnosis, rather than for 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?

On the last question, the institute said patients should be skeptical of any practice that cannot answer it. The Bonati Spine Institute declines patients whose conditions fall outside what its outpatient approach can address.

The institute performs the proprietary Bonati Spine Procedures in Hudson, Florida, using small incisions and local anesthesia, with patients leaving the same day. It also treats patients who have had prior spine surgery, including removal of previously placed hardware and treatment of failed back surgery syndrome. Imaging is read by a fellowship-trained neuroradiologist whose training includes Weill Cornell and Memorial Sloan Kettering.

About the Bonati Spine Institute:

The Bonati Spine Institute is a minimally invasive spine surgery center at 7315 Hudson Ave., Hudson, Florida, in the Tampa Bay area, founded in 1984 by Dr. Alfred O. Bonati. Its clinical team includes board-certified neurosurgery, anesthesiology and diagnostic radiology specialists. The institute performs outpatient cervical, thoracic and lumbar decompression procedures for herniated disc, spinal stenosis, sciatica, radiculopathy, spondylolisthesis, degenerative disc disease and failed back surgery syndrome, using patented instrumentation and techniques developed over more than 42 years. Patients travel to the Hudson facility from across the United States and internationally, and 65% arrive with a history of prior failed back surgery. Contact: 855-267-0482, bonati.com.

SOURCE Bonati Spine Institute