Think my 2 best options are.... Any Advice?

[longroadahead]

37 years, 185 pounds, 5'11. I am in Texas.

The ADR surgeons I have seen have mainly recommended a hybrid (fusion L5/S1 and ADR L4/5). My L4/5 MRI showed 2mm annular disc bulge with mild bilateral foramina stenosis and minimal flattening of the ventral thecal sac.

The neurosurgeons recommend mainly a TLIF (unilateral) or Microdisctectomy for the L5/S1 only and would not consider the L4/5.

Based on my research, think the hybrid is the way to go but think if I can get 5-10 years from my L4/5 the treatments available then will be better than they are now.

So that leads me down the path of just treating the L5/S1 for now. My insurance doesn't cover ADR but will cover most of the cost if done in conjunction with a fusion. I like the Kineflex but it is not FDA approved.

Will see one more surgeon next week then will try to make a decision. That will be 4 surgeons seen this year.

[Maria]

Option you mention sound that good to me. I've had 2 discectomies and they both rebulged and both within a short period of time ~ real short. One can never predict how long that option would last..you may do well you may not though most likely the disc level will rebulge and/or create more problems at some date.

Fusion. I dunno seems like if you have that at L5S1 and you already have a weakened disc level at L4 even if a small bulge chances are that level is going to have more stress on it and bulge more. Then again.. ??? who knows.

It'd be interesting to hear what maybe Dr. Zeegers and/or Dr. Bertagnoli or other surgeons of their skill/magnitude would have to say regarding your case and what they would do.

What I like about at least getting an opinion from them is they don't base it on what the FDA has approved in this country and what insurance will pay. It's based on what they think would work best for you and I believe they have everything to work with unrestricted. Although that's not to say there aren't extremely skilled spine surgeons in this country as well.

Unfortunately I know only too well how it is to have to consider what insurance will pay and/or financial constraints.

Good luck. I'm not sure my opinion counts for anything although I would only hope anyone considering spine surgery will do much better than I have with it.

[dshobbies]

If you're asking 'what would you do', I'd fuse S1/L5 and ADR L4/5. L4/5 is already compromised. The disco will further degenerate the disc which will most probably further degerenate in a very short period of time, leading to more pain and as follows, more surgery, this time with extra scar tissue.

Could the fusion and discectomy lead to several years of relief - yes. Is this probable, IMHO and based on personal experience and other posts, no.

This is your back and your decision. S1/L5 doesn't move much so fusing that space probably won't interfere with activities. But L4/5 is already bad and the chances of further degeneration, especially with the fusion below are pretty good.

BTW, if doctors don't perform ADR surgery, they're not likely to recommend it. The more honest opinions come from doctors who do it all. They won't be losing work by recommending anything and have no personal motives.

Please do your research. Minimal surgery at L4/5 will let you do it again, but just how much relief will you get and how long will it last?

Good luck, Dale