[Maria]

One of the reasons I didn't want to get ADR done here in the US (there were 2 major reasons) was that on 2 out of 3 discograms L3 which had anular tear and was disrupted wasn't a pain generator. L4 and L5S1 had already had surgery (discectomies) and were definate pain genertors. First when surgical recommendations were on board since 2001 I was advised to have a 3 level global fusion. Didn't think that was a good idea re success w/multi level fusion back then.

Then in 2003 recommended to have 2 level ADR at L4 and L5S1 and then in 2005 to have ADR at L4 and fusion at L5S1. Because this was a Worker's Comp case I knew only what was auth'd would be done then WC would be looking to get rid of my case quickly, dump it without auth'ing anything else surgically or probably heavy duty pain wise (like ESIs that I used to get great relief from but are no longer auth'd).

I worried that L3 would give me more trouble if I had the 2 lower levels worked on and not that level. Also in US no vertebroplasty done and I had osteopenia and later developed osteoporosis (several years later).

At least when I got a written eval from German doctors they said based on discogram results that they'd have to do there they'd let me know if I needed a 3 vs. a 2 level procedure. Also probably would have had vertebroplasty done there.

Last but not least where the surgery finally was authorized (or with the surgeon) at one point I was told that either a 2 level fusion or a hybrid surgery could be done. I was sure that a 2 level fusion would have left me screwed up at L3 even if a hybrid surgery wouldn't.

I didn't feel like having surgery for L4 and L5S1 and having to go back and have L3 done at some later point as my past luck hasn't been good with surgery and then adjacent level probs. I had a discectomy at L5S1 and one at L4 only nearly 2 years later and while the discectomy at L5S1 was Ok the one at L4 made me much worse and I suffered the aftermath terribly for 9 years before anyone would even talk about more surgery to me and no pain meds prescribed until that point as pain management had actually become a specialty that was really working on pain control vs. just prescribing PT and biofeedback and such. Ok that might not make much sense tho I've tried to condense a long history into something short.

I see you've gotten 3 opinions and there's a concensus on replacing L4 as well. Good luck with your decision. Seems like you've done your homework re 2nd and 3rd surgical opinion.