The Disc Replacement Book - Chapter 3

The Disc Replacement Book

To Fuse or Not to Fuse?  This is the question!  Spinal FusionDisc Replacement or another option?

We can help you understand your options, from spinal fusion alternatives to disc replacement options?

Why Disc Replacement?

In the last decades medical technology has moved forward at a faster than ever pace. Yet many spine surgeons remain stuck in the past, limited by regulation they are still using fusion surgery or outdated disc replacement technology. Are you asking Disc Replacement versus Fusion Surgery?

Due to FDA restrictions, limitations of the approved products, and the inexperience of many surgeons, many patients will be exposed to unnecessary risk, get debilitating fusion surgery, or continue to suffer needlessly. Most, never knowing there are better options available, technology that can preserve the natural motion of the spine, and surgeons with the experience required to help them.

Why Disc Replacement versus fusion surgery?

There are several concerns with spinal fusion surgery. Overall success rates are very low and the recovery is long and painful. Even after a "successful" spinal fusion, problems begin to develop soon after the fusion surgery. The segments next to the Fusion Surgery have more forces applied causing "adjacent level degeneration" which studies have shown will lead to additional pain and surgeries.

In this new book Spine Surgeon Dr. Ritte-Lang explains how Artificial Disc Replacement, Hybrid surgeries that may include multiple types of intervention, and Fusion Surgery Alternatives are changing the way we think about the "Gold Standard" Spinal Fusion Surgery.

What this book will teach you

Spinal fusion surgeries are on the rise.

In fact, spinal fusions are now the most common spinal surgery by far!

What once was a surgery of last resort is now performed over 400,000 times a year in the U.S. alone!

You will discover...

How Post Fusion Surgery Adjacent Segment Degeneration causes many fusion recipients to require more and more fusion surgery!

How Artificial Disc Replacement and hybrid interventions are helping patients get their lives back!
How patients are trading multi-level fusion for multi-level disc replacement surgery!

Why skiing, surfing, golf, horseback riding and even Ironman Traithlons are no longer a thing of the past for those who have suffered severe back pain!
And much, much more!

It's time to get your back BACK!

About The Author

Karsten Ritter-Lang, M.D., is a world-renowned leader in reconstructive spine surgery.

Dr. Ritter-Lang worked and taught at the Charite University Hospital, widely recognized as the birthplace of the first effective artificial disc replacement.

Dr. Ritter-Lang has been a specialist in the field of intervertebral disc prosthetics for over 20 years. He has performed approximately 7,000 surgeries, over 4,000 of which have involved artificial disc replacement. He has also performed several thousand spinal fusion surgeries and hundreds of hybrid interventions in his ongoing career.

His participation in the ongoing development of intervertebral disc replacement technology, prototypes, and implants makes him a valuable resource for other spine surgeons, who travel from around the world to observe and model his surgical techniques.

Spinal Fusion Alternatives - Disc Replacement and Hybrid Interventions

Disc Replacement often referred to as “ADR,” artificial disc replacement (or simply disc replacement) involves removing a damaged or compromised disc in the lumbar or cervical spine and replacing it with an artificial disc, a specially-designed implant created to mimic the natural function of the disc.

By inserting the artificial disc into the spine in place of a damaged or deteriorated disc, the normal movements and strength of the spine can be restored. Restoring normal motion and strength at the level of the artificial disc also assists discs at the levels above and below the artificial disc by alleviating any additional strain caused by a deteriorated disc, or a fusion designed to treat a deteriorated disc.

Dr. Spiller, Chief Surgeon describes this process in more detail in the book.

From start to finish, disc replacement surgery usually takes our team less than 75-minutes, and that includes 2- and 3-level disc replacements as well. These procedures can be done in a very efficient manner because of the number of surgeries we have performed together as a team and due to the fact that we perform disc replacements many times a week on average. Because the surgery is short, the patient is under anesthesia for only a short time.

Side or lateral view of a properly implanted Spinal Kinetics M6-L Lumbar Disc Replacement Implant.

The design of the implants themselves varies siginifcantly and has for years; initial efforts at disc replacement involved borrowing successful technology from knee and hip replacements in an effort to incorporate them into spinal treatment. Surgeons had been replacing knee and hip joints for many years, so such methods were taken and employed for the spine. The initial results were promising but imperfect. Early artificial discs involved a ball-and-socket style joint. While this is a perfect type of joint for a hip, it is not the perfect solution for the spine. Early artificial discs (and even some current ones used in North America today) allowed too much motion, more than a natural disc allowed. This additional motion had the potential effect of placing more pressure and strain on surrounding tissues and structures. Early discs also tended to “migrate” or move out of optimal position. This caused several challenges and, in time, required removal or replacement of the implant. Lastly, while disc replacements have advanced over time, nearly all implants lacked another critical function of the disc: shock absorption.

The spine is, among other things, like a large shock absorber that allows us to move, run, and jump without sustaining injury. The spine accomplishes this through a combination of curvature of the spine and the compressible nature of the discs. Each disc in your spine can compress a small amount. Multiply this amount across all the discs, and you have a very effective shock absorber for the body. The early artificial discs could not compress at all, so they lacked this important function. 

Over the years, several generations of artificial discs have been developed. The latest and most effective ones restore the proper amount of motion to the spine and provide an amount of compression or shock absorption similar to a natural disc. The first disc to effectively incorporate shock absorption is the M6 disc from U.S.-based Spinal Kinetics. Unlike other implants, the M6 allows motion in all planes, but in a way that is limited like the natural disc. It allows forward, backward, and side-to-side bending. It also allows twisting. But the limited compression of the disc makes this disc the first to truly replicate a normal disc. Because it is constructed from a combination of rigid and flexible materials, it provides a level of shock absorption very similar to a natural disc.

Only with the M6 prosthesis, which we have been using in the cervical spine since 2005 and in the lumbar spine since 2009, has a prosthesis become available that can biomechanically mimic the natural disc. In addition, the M6 prosthesis has been thoroughly investigated biomechanically and has shown very high durability in testing. The M6 prosthesis can complete 30 million cycles of motion without exhibiting any significant wear or damage. This means the prosthesis will likely last at least 60 to 75 years before suffering wear. This is far superior to the wear cycle of the human disc. For this reason, the M6 disc is preferred around the world by spinal surgery teams that specialize in artificial disc replacement. In fact, as of the writing of this book, over 43,000 M6 discs have been implanted worldwide. 

Artificial disc replacement has now been shown to be far superior to traditional fusion for the vast majority of patients with degenerative disc disease. While fusion is sometimes still indicated, many spinal fusions can be avoided through effective artificial disc replacement, and usually with far superior results. In addition, disc replacements at multiple levels are quite common and can be performed without increased complications. While there is a common understanding among many people that more fused levels equal more problems, the same is not true for artificial disc replacement. If the proper implant is used, the artificial disc mimics the natural disc. Therefore, the presence of multiple artificial discs does not increase the likelihood of short or long-term complications. Many patients, rather than undergo a multiple-level fusion, will have multi-level disc replacement. Where indicated, two-, three- and four-level disc replacement can be accomplished in one surgery and with excellent results. While it is rare that we would implant four artificial discs, it can and has been done with superb results. In fact, we find that the complication rate for multi-level interventions is roughly the same as for single-level interventions.