William Capicotto MD

08/10/2026

Spine surgeons love to talk about adjacent segment degeneration when the disc next to a fusion deteriorates. Did you know that if the bone is a bit soft next to a fusion the bone can fracture? Well it can and it does. I’ve seen this many times over the years in patients that have a long standing fusion that become osteoporotic in their 70s and 80s and unfortunately suffer a fracture next to the fusion. Also, this is a case done in the 1990s with an open technique that devitalized all the muscle distal to L3. I’m sure this has something to do with the instability and fractures. Very few surgeons use this technique any longer.

08/10/2026

Yes, I’m being sarcastic. However, there’s truth in what I say. The science clearly shows that total disc replacements perform better than spinal fusions. In particular, the rate of second and third surgeries after a total disc replacement is far less than after a fusion for the same type of condition. If a person has a spinal fusion, there is an excellent chance they’re going to have to have a second or third or perhaps even a fourth spinal fusion. That’s great for the surgeon. That’s great for the hospital. That’s great for the device manufacturer. That’s definitely not so great for the patient. We now have superior technology that not only maintains motion, reduces pain, returns people back to work and vigorous activity and leads to less second, third and fourth surgeries. That technology is called total disc replacement.

08/10/2026

I beg to differ. Total disc replacements have undergone rigorous scrutiny by FDA and our safe and effective over both short and long-term. Here is a quick AI summary:
AI Overview +7 Yes, it is widely cited by spine experts and professional societies—such as the International Society for the Advancement of Spine Surgery (ISASS)—that total disc replacement (TDR) is backed by an exceptionally robust body of Level I clinical data (prospective, randomized controlled trials) compared to nearly any other Class III medical device category.Nature of the EvidenceFDA Regulation: TDR devices underwent intense scrutiny via multi-center, prospective, randomized Food and Drug Administration (FDA) Investigational Device Exemption (IDE) trials for Premarket Approval (PMA).Comparison Data: These high-level trials directly compared motion-preserving artificial discs against standard spinal fusion procedures over multi-year periods.Long-Term Follow-Up: Registry and cohort studies have continued to track cohorts past 10 to 20 years, confirming low device-failure and revision rates.

08/10/2026

Total disc replacement is one of my favorite procedures to perform. In general patients do really well. However, it is not the procedure for everyone. This person has a congenitally narrow canal with quite a bit of stenosis. A total disc replacement in 2026 is not the appropriate procedure for this person. This person is more of a candidate for a spinal fusion. In the next few days, a posterior procedure with laminectomy and fusion will be performed.

08/10/2026

Cooking for others is fun. Cooking for your children or grandchildren is extra special. Enzo wanted octopus. I added a little calamari, scallops and pasta. I think he liked it… I sure did.

08/07/2026

Ignore me at your own risk! As I stated above, if your spine surgeon does not discuss or disparages spinal endoscopy or total disc replacement get another opinion. Do your research. The reason we no longer use 8 track tapes or cassette tapes is because we have much better technology. After being in practice for 40 years and performing total disc replacements for 20 years, I can assure you that spinal endoscopy and total disc replacements are the real deal.

07/31/2026

Sometimes bigger ain’t better… It’s just bigger. Modern spine surgery tries to precisely target the problem and treat it in the most ultra minimally, invasive manner. Welcome to endoscopic cervical spine surgery.

07/30/2026

Consistent with long-term studies. 16 years post four level Pro Disc C total disc replacement. No neck pain. Very little adjacent segment degeneration. No second or third surgeries. Compare that with a four level ACDF… !

07/10/2026

Sunday Funday!!!

07/10/2026