Non invasive spinal surgery??

[billethkid]

I did a search on Gulf Coast Spinal Institute and doctors Ronzo and Bono.

After a fair amount of research I concluded there are no others who "specialize" in the non invasive procedure.

I had my MRIs done and consulted with Bono. Diagnosed with a ruptured disc in the lumbar area of the spine.

I am impressed with Dr. Bono. Their facility in Tampa is state of the art and specifically designed for non invasive spinal procedures.

The bad news was because their facility does not meet medicare guidelines....their facility is too specific....there are some costs that are out of pocket that would not be at a hospital (with standard open surgery).
Estimated cost.....$13,000.

That is a lot of money however if it does everything as advertised and the procedure is not available anywhere else.....one has to give the option due consideration.

Any others experienced with these doctors and costs.

Anybody aware of any other organization that does the non invasive procedure?

[delima2000]

What about the facility in spring hill? I know two people that went there and had dr Bono do the procedure and medicare,paid for it. I Better check that out because my husband is seeIng dr.bono on Thursday to see if he can do something for him.

[Mudder]

Think about going there and paying all that money really hard. Most, not all, of their patients who have had great long term success are younger than 60. Much depends on your age, overall health, etc...as to how you will do with their services. Truth is only a small percentage of people with herniated disks actually get long term pain free living. I do know someone who was totally pain free for 2 years after going there, but then...Bam...that same old disk acted up again. I for one decided to take the route of exercise and a small change in activities and intensity to keep my three herniated disks 95% pain free. If you decide to be treated there I wish you good luck and pain free living.

[billethkid]

What about the facility in spring hill? I know two people that went there and had dr Bono do the procedure and medicare,paid for it. I Better check that out because my husband is seeIng dr.bono on Thursday to see if he can do something for him.

They only have one surgical center that is in Springhill/Tampa some where. If you go to their website they do have a collage of insurance they take and medicare is not listed. If you/he are anticpating medicare to pay you/he will find the same as I did....

[PattyPan1]

Hi,

My husband is having surgery in about 4 hours with Dr. Bono, we are going to Oak Hill Hospital for the procedure and they cover Medicare with a night stay over. I can let you know the results.

[asianthree]

So what procedure are they doing

[billethkid]

Expenses by the doctor at the offices is covered by medicare.

Doctors expenses for the surgery are covered.
Facility fees for the BioSpine Center are not covered. They have applied for medicare approval but do not have it at this time.

[billethkid]

for others who may be interested in the outcome of my pursuit of medicare or not regarding Dr. Ronzo and Dr. Bono and the BioSpine Institute.

I just talked to a representaitve of Dr. Bono regarding where surgeries are done and what is covered by medicare or not.

Until recently they have been sheduling their surgeries at Oak Hill hospital and everything done there was/is covered by medicare.

They have notified Oak Hill they are no longer performing there effective sometime in March which is how far out they are booked.

The new facility is BioSpine where all future surgeries will be done. Dr. Bono is a medicare approved surgeon and his fees will be paid. The facility is not (yet) medicare approved and has to be paid by the patient.

And as stated in my original post Dr. Bono said it would run around $13,000 for a lumbar laminectomy.

I was also told they are hopeful to be an approved facility by year end....but did not know for sure.

So yes there are some who have had surgery by these docs that was paid for by medicare. And no it will not be paid for any done at their new facility BioSpine.

For a point a interest Ronzo and Bono are the top two surgeons in the USA in the number of non invasive surgeries performed. They are in the top 5 in the USA for outcome.

[Carla B]

May I ask how noninvasive differs from invasive. Did you look at Ocala Neurosurgical? I know someone who had an invasive spinal fusion at Ocala in the cervical area and a spinal fusion and laminectomy on L4 and L5 in another location. Both were quite successful.

[blueash]

Do I understand that these surgeons had a working agreement where all your costs were covered including their entire fee and the separate fee to a facility which they don't own was covered... and now they have built their own facility which will allow them to also collect the facility fee as well as the surgical fee? And that they are opening that new facility before they have cleared the requirements of the most common insurance with which they need to deal? And that as well all know insurance companies negotiate a much lower charge for the facility than what the non-insured are charged so in this time before approval they will make even more as no write off?

Anyone out there who had the surgery at Oak Hill, what was your facility fee after the insurance discount?

If you want this surgery and cost is a concern

1. Ask for an Oak Hill date when one becomes available. There are always patients who cancel at the last minute or fail their pre-op EKG or whatever. Be ready to fill in

2. Negotiate. Yes you can. The 13K is the asking price. You can be sure that they will not be getting anything near that once the Medicare discount kicks in.

3. Wait until they are approved.

[blueash]

A google search using minimally invasive spine surgery Florida (it is not NON invasive) will provide you will the names of many other Florida physicians doing the procedure. I reviewed Dr. Frank Bono's website after I was unable to find a single article he had written using google scholar. On his website he gives some statistics for his success and complication rates. They claim that

Less than 10% of all spine surgeons perform the "true" minimally invasive surgery. Know your surgeon – experience matters

Our infection rate is less than 1%, just ask Consumer Reports

I have no idea what they mean by "true". I can't find any documentation that they have done this procedure more than anyone else in the country although it may be true. That either means they are the most active practice (good), or they are doing it to everyone who walks into the office as opposed to being selective with operative candidates (bad).

The Consumer Reports link says that Citrus Hill Hospital (where they are leaving) is top ranked in Medicare data for low rates of death and extended hospital stays in spine surgery. From the link provided there is no mention of infection rates and all spine surgeries are included not just those by this doctor group nor just minimally invasive. However, if we accept their infection rate as accurate, is that better than other surgeons as their pride would suggest?

Moreover, minimally invasive spinal procedures seem to be associated with a much lower infection rate than open procedures (0.5 %)
http://journal.frontiersin.org/article/10.3389/fmed.2014.00007/full

So less than 1% is true for everyone nationwide

And, just one of my things, I am unhappy to see anyone violating the well known Consumer Reports warning against any use of their ratings for advertising.

"Consumer Reports' "No Commercial Use Policy" prohibits the use of our content in advertising. We carefully monitor the use of our name and ratings to preserve our reputation as a not-for-profit source of information that is neither influenced nor associated with any commercial interest. The policy prevents companies from using our name and ratings to promote their own sales or to disparage the products or services of their competitors"

none of this is to suggest that having this surgery by this doctor is anything other than a great choice. I have no idea. But the marketing seems too slick for my taste.

[delima2000]

It is not citrus hills hospital it is oak hills hospital.

[blueash]

It is not citrus hills hospital it is oak hills hospital.

Yes, my error, Which then leads to the question if their website refers to surgery at Citrus Hills hospital done by this group, would the OP have the option of having surgery there in that Medicare approved place or are they leaving all the approved places where they practiced?

I am wondering what the procedure might be to get Medicare approval for an ambulatory surgical center.. ?

[billethkid]

minimally invasive by Bono and Ronzo is operating through a one inch long incision. Minimal blood loss. No cutting of muscle tissue. Almost no infection. Out the door the same day. Back to driving a car after 24 hours. Swing a golf club after one week.

Traditional surgery is a minimum of 6 inches long by 4 inch wide opening in the body to get at the same spot. Significantly higher infection exposure. Higher blood loss. Two to 4 days in the hospital. Weeks of recovery with physical therapy.

Not selling anything here. I have been researching the options for some time.

Laser repair is not the same as minimally invasive and is more invasive.

If one needs to have a spinal repair surgery (or any other surgery for that matter) then they become very motivated to spend the time doing the research and understanding all the options.

And if one is fortunate enough to have a problem that is not urgent then take the time......like maybe wait for BioSpine Institute to get medicare approval....which they will.

[asianthree]

Well just my two cents but size of the incision doesn't mean a whole lot compared to that infection rate. A good OR staff is what causes less infection right not the size of an incision. I have seen an incision from stem to stern without any infection whatsoever. And have seen a 1 inch incision come back infected. Well trained staff is your key to no bring back

[dbussone]

Well just my two cents but size of the incision doesn't mean a whole lot compared to that infection rate. A good OR staff is what causes less infection right not the size of an incision. I have seen an incision from stem to stern without any infection whatsoever. And have seen a 1 inch incision come back infected. Well trained staff is your key to no bring back

And the cleanliness of the facility, and the processing of the surgical instruments, etc. etc. etc. it's more than just the OR staff. They are important - but not solely responsible.

[Seekingretirement]

There are many good orthopedic and neurological surgeons in central Florida, and they all offer minimally invasive surgery (MIS), the new standard. MIS is always preferred if it can be used to minimize pain and recovery time.

I found Jewett Orthpaedic Clinic in Winter Park. This practice was founded in 1939 and has an outstanding reputation. They are the practice of choice for the Orlando Magic, the Predators (arena football team), and Cirque du Soleil. They have 25 doctors on staff, organized into specialty groups. The spinal surgery group includes 5 surgeons.

A herniated disk was pressing on a nerve coming out of my spine. The sciatic pain from the hip to foot of my left leg was pure agony and nothing would solve the problem short of a micro diskectomy. Dr. Gregory Munson performed the surgery at Florida Hospital South in Orlando. I cannot say enough positive things about Dr. Munson, his staff, and the hospital. With all private rooms and an attentive and considerate staff, the hospital stay was exceptional. Dr. Munson asked the admitting physician to keep me under observation over night, because I was admitted only after clearance from my cardiologist. Medicare covered everything.

There is a 5% chance of the problem returning, usually in 5-7 months. Having read some of the comments here, I have to think that at least some of those cases are the result of people failing to take the lengthy recovery period seriously.

[Carl in Tampa]

I suffered "age related lower lumbar stenosis" complicated by a trip-and-fall injury to my thoracic spine before I could get the stenosis treated. The fall left me with three crushed vertebra which was so painful that I sat in a recliner chair 24 hours a day. The pain was so great that I could not lie down in bed.

When Dr. Ronzo saw my MRI he told me he could remove the pain with kyphoplasty using minimally invasive surgery. He did. It did not solve all of my problems but it got rid of the intense pain. The incision was so small that it was covered with a band-aid. I could have been released from the hospital on the same day as the surgery if I had not had an allergic reaction to an antiseptic that they used on my.

The surgery was at The Villages Regional Hospital and Medicare and my secondary insurance (BC/BS) paid for it.

My other spinal problems were so extensive that my primary care doctor wanted me to go to a highly regarded surgeon in Ocala. That doctor was so concerned that he had me consult with an Orthopedic surgery instructor at University of Florida (Shands Hospital). My subsequent surgery, both lower lumbar and thoracic spine, involved major open incisions and repair.

I don't know what to say about a herniated disc, and am not sure that a laminectomy is even the proper procedure to repair it.

Good luck on whatever you decide to do.

[Dr Winston O Boogie jr]

minimally invasive by Bono and Ronzo is operating through a one inch long incision. Minimal blood loss. No cutting of muscle tissue. Almost no infection. Out the door the same day. Back to driving a car after 24 hours. Swing a golf club after one week.

Traditional surgery is a minimum of 6 inches long by 4 inch wide opening in the body to get at the same spot. Significantly higher infection exposure. Higher blood loss. Two to 4 days in the hospital. Weeks of recovery with physical therapy.

Not selling anything here. I have been researching the options for some time.

Laser repair is not the same as minimally invasive and is more invasive.

If one needs to have a spinal repair surgery (or any other surgery for that matter) then they become very motivated to spend the time doing the research and understanding all the options.

And if one is fortunate enough to have a problem that is not urgent then take the time......like maybe wait for BioSpine Institute to get medicare approval....which they will.

I've had three disc operations and they were all done with a one inch incision. The first was done at Massachusetts General Hospital and the others were done at the New England Baptist Spine Center. NE Baptist is ranked as one of the top orthopedic hospitals in the world. People come from all over the world to be treated there. Jack Nicklaus had a hip replacement there. Larry Bird had his back operated on there and the King of Saudi Arabia was being treated there at the same time as I.

My surgeons told me that almost no one is doing basic discectomies or lamanectomies using 4-6 inch decisions any more. My first surgery was in 1989.

After my first surgery, I stayed overnight and came home the next day. I was up and walking within 30 minutes of coming out of the anesthesia. The second two surgeries, I was home the same day.

Big incisions and two to three day stays at a hospital are archaic.

It seems to me that "non-invasive" and surgery are conflicting terms. Minimally invasive is pretty much standard procedure today.

I went through several different non-invasive procedures prior to my surgeries. A good surgeon will try to avoid surgery. But, if a patient is having severe pain down the leg and foot for more than three months, it's time to have the surgery. After three months, the chances of the situation improving is almost zero.

[MoeVonB61]

Think TEN times (and get 3 opinions, asking to speak with former patients) before someone touches you for any kind of surgery there is NO reversal to pathological impact of the scar tissue!! BTW, are Ronzo and Bono members of the "Association for Medical Ethics in Spine Surgery"???
http://www.ethicaldoctor.org/about-ame/

[NotGolfer]

I can't speak to this practice, however I can tell of my experience with non-evasive spinal surgery. I had a discsectomy 4 yrs ago by Dr. Spurrier (who no longer in in The Villages). He's a neurosurgeon and didn't do surgery unless it was indicated. My experience was a ruptured lumbar disc which was excruciating. The surgery left 'maybe' a 2" scar and the recovery time was 2 weeks after which I was given the "go and do anything you want" from the doctor. I would do my homework if I were to have any spinal surgery. Not sure I'd have an orthopedic surgeon do it but it they have high accredidation and they're the only ones available, then perhaps. I've heard of a neurosurgical practice in Ocala....have you checked with them??

[Villages PL]

There are always patients who cancel at the last minute or fail their pre-op EKG or whatever.

I could be wrong, but from reading previous posts I think this may be the problem that prevents surgery. To be clear, are you saying a heart condition would make the OP ineligible for surgery?

[Carl in Tampa]

I could be wrong, but from reading previous posts I think this may be the problem that prevents surgery. To be clear, are you saying a heart condition would make the OP ineligible for surgery?

In my experience, my surgeons required a written clearance from my cardiologist before the surgeons would operate.

The form indicates the level of risk involved, which includes low risk, medium risk and high risk. Approval is sometimes given even when it involves high risk because going without the particular surgery would leave the patient with an unacceptably poor quality of life.

There is a separate sentence where the cardiologist either approves or disapproves the surgery.

[billethkid]

In my experience, my surgeons required a written clearance from my cardiologist before the surgeons would operate.

The form indicates the level of risk involved, which includes low risk, medium risk and high risk. Approval is sometimes given even when it involves high risk because going without the particular surgery would leave the patient with an unacceptably poor quality of life.

There is a separate sentence where the cardiologist either approves or disapproves the surgery.

Dr. Bono does require the release/approval of my cardiologist prior to scheduling surgery.
I am still investigating. I have not decided what if anything to do. I am fortunate that pain or debilitation is chronic......but when it flares it is very miserable.

[Dr Winston O Boogie jr]

I can't speak to this practice, however I can tell of my experience with non-evasive spinal surgery. I had a discsectomy 4 yrs ago by Dr. Spurrier (who no longer in in The Villages). He's a neurosurgeon and didn't do surgery unless it was indicated. My experience was a ruptured lumbar disc which was excruciating. The surgery left 'maybe' a 2" scar and the recovery time was 2 weeks after which I was given the "go and do anything you want" from the doctor. I would do my homework if I were to have any spinal surgery. Not sure I'd have an orthopedic surgeon do it but it they have high accredidation and they're the only ones available, then perhaps. I've heard of a neurosurgical practice in Ocala....have you checked with them??

Funny I had a client and friend who was a neuroradiologist on staff at Mass General Hospital and he told me that the best people to do these procedures are orthopedic surgeons who specialize in the spine. In fact most of the docs that do them at NE Baptist are orthopedic surgeons. They are highly specialized however. The guy that did mine specializes in surgery of the lumbar region.
What you don't want is some guy who does a shoulder in the morning followed by a knee replacement and then is going to mess around with your spine after all that. You want a doc that does spine surgery only.

[DougB]

I can't speak to this practice, however I can tell of my experience with non-evasive spinal surgery. I had a discsectomy 4 yrs ago by Dr. Spurrier (who no longer in in The Villages). He's a neurosurgeon and didn't do surgery unless it was indicated. My experience was a ruptured lumbar disc which was excruciating. The surgery left 'maybe' a 2" scar and the recovery time was 2 weeks after which I was given the "go and do anything you want" from the doctor. I would do my homework if I were to have any spinal surgery. Not sure I'd have an orthopedic surgeon do it but it they have high accredidation and they're the only ones available, then perhaps. I've heard of a neurosurgical practice in Ocala....have you checked with them??

I had Lumbar Spinal Fusion (L4, L5) performed on me 22 years ago by an orthopedic surgeon. He was assisted by a neurosurgeon. Been pain free since the surgery. I also had the same orthopedic surgeon perform Cervical Spinal Fusion 8 years ago.

[Villages PL]

Do doctors recommend for or against golfing after surgery?

It seems to me that the human spine was not designed for golfing. Cavemen didn't play golf, golf has come about sometime in the early 1400s.
Could be that the human spine has not had time to adapt. :)

[dbussone]

Do doctors recommend for or against golfing after surgery?

It seems to me that the human spine was not designed for golfing. Cavemen didn't play golf, golf has come about sometime in the early 1400s.
Could be that the human spine has not had time to adapt. :)

I had an L4L5S1 fusion in 1969. Took up golf in 2012. I'm not a very good player but I think it helps keep me a little more limber and my doc has not discouraged me from playing. I think it is a matter of individual ability and interest.

What do you think?

[Villages PL]

I had an L4L5S1 fusion in 1969. Took up golf in 2012. I'm not a very good player but I think it helps keep me a little more limber and my doc has not discouraged me from playing. I think it is a matter of individual ability and interest.

What do you think?

Good for you! I suppose it can be done. I haven't done any research on this.

[billethkid]

Inactivity is the enemy of your body....especially at our age.

[dbussone]

Inactivity is the enemy of your body....especially at our age.


Amen to that.

[Cathy H]

Lots of good advice for you so far. all surgery is invasive. don't use docs who won't take medicare plus the suplemement. If your pain "comes and goes" its not as serious as I have heard about and experienced. do check out the many references sent to you here.

[LuckySevens]

I did a search on Gulf Coast Spinal Institute and doctors Ronzo and Bono.

After a fair amount of research I concluded there are no others who "specialize" in the non invasive procedure.

I had my MRIs done and consulted with Bono. Diagnosed with a ruptured disc in the lumbar area of the spine.

I am impressed with Dr. Bono. Their facility in Tampa is state of the art and specifically designed for non invasive spinal procedures.

The bad news was because their facility does not meet medicare guidelines....their facility is too specific....there are some costs that are out of pocket that would not be at a hospital (with standard open surgery).
Estimated cost.....$13,000.

That is a lot of money however if it does everything as advertised and the procedure is not available anywhere else.....one has to give the option due consideration.

Any others experienced with these doctors and costs.

Anybody aware of any other organization that does the non invasive procedure?

I am so sad to hear this. My husband has 5 bad discs, L1-5 and I have L4-5 and S1 with severe sciatica. Just today, our Internist told us to make appointments with Dr. Bono to discuss surgery. After hearing this about their new facility not taking Medicare, I'm afraid that leaves us out.

[dbussone]

I am so sad to hear this. My husband has 5 bad discs, L1-5 and I have L4-5 and S1 with severe sciatica. Just today, our Internist told us to make appointments with Dr. Bono to discuss surgery. After hearing this about their new facility not taking Medicare, I'm afraid that leaves us out.

Keep checking with them. What they are probably lacking is the necessary inspection by the state health department before a license can be granted. Once that occurs the facility will be granted "deemed" status by Medicare. I seriously doubt that they have made a decision to NOT accept Medicare. That does not make good financial sense in FL. If they have, I'd certainly be surprised.

[Villages PL]

What's the cause of "bad discs"? Does it have anything to do with osteoporosis of the spine? Is it possible for both to occur at the same time?

http://nof.org/articles/18

[delima2000]

The doctors take medicare and the supplements but the new facility is not yet approved. Husband is going to wait until they get the approval.

[billethkid]

Update on Dr. Ronzo and Dr. Bono.
of Gulf Coast Spine Institute and Biospine in Tampa.

My daughter had the minimal invasive surgery yeaterday. All went as expected and 5 hours later she walked to the car!!!!

While at the Biospine location I did have a chance to talk to Dr. Bono about medicare. He confirmed again the new facility is not covered by medicare and could "take a year or two to get approved". That is approval for the facility. The doctors are coverd by medicare.

I know I stated it before but for me to have the surgery at their new facility would cost around $13,000. I am fortunate to have a condition that is chronic. And I can extend the time between episodes by being more careful.
I continue my search for medicare approved coverage for the minimally invasive procedure.

[Balesschool]

I am looking for recommendations for surgeons who do minimally invasive surgery for stenosis of the back.

[jnieman]

I am looking for recommendations for surgeons who do minimally invasive surgery for stenosis of the back.

A friend of mine just had minimally invasive back surgery from Dr. Hill and is pleased. She is back to doing everything except golf at this point and it has just been 3 weeks.

[hulahips]

Another vote for Dr bono who Dad just had spine surgery by