The Disc Replacement Book- Chapter Four

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 Yet many spine surgeons remain stuck in the past, limited by regulation they are still using fusion surgery or outdated disc replacement technology.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. Ritter-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.

About Disc Replacement - FAQ


THE LENGTH OF time it takes to complete Artificial Disc Replacement surgery can vary significantly depending on the skill and experience of the surgeon and the surgical team. The typical spinal surgeon who performs ADR a few times a month may take two or more hours for a single-level ADR procedure. On the other hand, if the surgery is being performed by a highly experienced surgeon and team, this time falls considerably. At our hospital, where we perform multiple ADR surgeries every week, a single-level ADR takes approximately one hour and 15 minutes. A multi-level disc replacement is usually accomplished within 90 minutes. Even a hybrid procedure, where ADR and fusion are combined, takes our team only about 90-120 minutes, largely because of our experience and skill with these procedures.

This is very important if you or a loved one are considering spinal surgery. The amount of time you spend in surgery is critical to your recovery. The longer you are in surgery, the higher the chance for problems and complications. The shorter your surgery, the less blood loss you may sustain, the less time you are under anesthesia, and the lower your chance of infection. It stands to reason that the chance of infection increases the longer your surgery is underway. The sooner your wounds are closed and sutured, the better. You want to be exposed to potential complications for as little time as possible.

The short surgery times at our hospital are one of the reasons we have a very low infection rate. Our general infection rate is 1.8%, far below the average surgical suite. Hospital infection rates are carefully monitored in Germany, and tracking is mandated by law. The truth is, we have never had an instance of a primary infection following disc replacement surgery. While we have had the inevitable low-grade infections in a few cases, the occurrence has been less than 1 in 1,000.


Unfortunately, your access to Artificial Disc Replacement and hybrid intervention may be hampered by your location. While ADR has been performed for decades in other parts of the world, the U.S. and Canada have been slow in coming up to speed with the procedures. This is not due to any specific problems with ADR or hybrid intervention but simply because of the regulatory processes and medical systems in these countries.

Currently, in the U.S., the most commonly used device is the Pro Disc, which is approved for single-level use only. For a time, the Pro Disc was one of the best artificial discs available. But it has not aged well, so to speak. In fact, by the time the Pro Disc was approved for use in the U.S. by the Food and Drug Administration (FDA), it was already considered obsolete in Germany and other countries where disc replacement is frequently performed. Ongoing studies of the Pro Disc show a higher than necessary complication rate along with concerns for facet arthrosis. Unlike the M6 device, which mimics the normal, limited motion of a natural disc, the Pro Disc allows more than normal motion. This is one of those times when more is not better. The resulting hypermobility increases the stresses on the facets (portions of the vertebrae above and below the artificial disc). Over time, this can cause damage.

The Pro Disc has also had a rough track record when it comes to the need for revision surgery. In fact, studies have shown that the device has required as much as 8.7% of the patients to have a second surgery within two to three years (Siepe, Mayer, Wiechert, & Korge, 2006). Yet the ProDisc is still used for single-level disc replacement in the U.S. and Canada.

Meanwhile, the Spinal Kinetics M6 Implant, for instance, is used in 27 countries around the world, and over 43,000 devices have been implanted since it was released in 2006. I had the honor of being the first surgeon ever to implant the M6-L (lumbar) artificial disc, and I have implanted thousands of them since. I was also the first surgeon in Europe to implant the M6-C (cervical) disc. Fortunately, FDA testing is now underway for its use in the U.S. While it may be still several years before the device sees widespread use in the states, it seems highly likely that the Spinal Kinetics M6 will become a valid treatment option for people there. 

Sadly, there is an additional challenge. The FDA has been very slow to approve multi-level artificial disc replacement. A high percentage of patients require treatment at more than one level of the spine. A doctor’s recommendation for a two or three-level fusion seems more and more common these days. For U.S. patients, though, only one lumbar level can be treated with ADR (typically in the form of a Pro Disc). And, as of the writing of this book, only two cervical devices have been approved for multi-level use, and that only in limited circumstances. (FDA, 2016)

The remaining level(s) must instead be fused, even when an additional level of disc replacement might be the best solution. While this is often better than all of the injured levels being fused, it does not compare well to the restored function and decreased pain that we see with multi-level disc replacement. There may come a time soon when multi-level ADR will be common in the U.S. and Canada, but, for now, surgeons in these countries are sadly limited in their treatment options.

Even though the M6 (which is actually made in the U.S.), is going through the FDA approval process, my sources indicate that, even when it is approved, it will still only be approved for single-level use. Frankly, common multi-level use of state-of-the-art artificial discs may be a decade or more away in North America. By the time the FDA has given approval for multi-level ADR with the M6, the state of the art may have advanced to other disc implants and techniques.

For these reasons, patients often travel outside North America for disc replacement. To get the best possible treatment, they engage in what some call “medical tourism.” This term doesn’t describe getting treatment while on vacation; instead it refers to a more and more common practice of traveling to the part of the world that holds the best solution.

Many people who own a car will seek out the “best” mechanic. How you personally determine which mechanic is “best” may vary, but many people will consider the mechanic’s experience working on their model of car, the mechanic’s state-of-the-art diagnostic equipment, and repair options. Price also may come into consideration. Well, the best mechanic for your car may not have his shop in your neighborhood. You might have to drive across town to seek repairs if you want “the best.

This is true for medical treatment too. The best medical solution may not be available in your neighborhood…or nation. By one estimate, 1.4 million people engaged in medical tourism in 2016. (Patients Beyond Borders, 2016) Whether they travelled for different treatment options, better care, or more affordable treatment, they all left their “neighborhood” and drove “across town” for medical care. In the case of spinal surgery options, the best surgeon, surgical team, hospital and devices may not be available where you live. Traveling abroad may be required.

Disc replacement has been performed for many years in Germany. While disc replacement may be available in other countries, it is my belief that spine treatment options in Germany are excellent. High levels of care, low infection rates, and state-of-the-art devices make Germany a very attractive alternative for disc replacement and spinal surgery in general.

For more Disc Replacement FAQs please get the book here > >