ADRSupport Community - ADR Surgeon in New England

Hello folks. I came across this website 6-7 years ago when I was debating lumbar ADR for the first time. After extensive research after 2 failed microdiscectomies on L5-S1, I ended up fusing L5-S1 in 2015. I did not want the fusion, but at that time I thought the lesser of 2 evils was the fusion. The entry through the front, the risk of potential future issues w/prosthesis, my need for posterior decompression, I decided on the TLIF fusion.

Also, the ADR would have been 2-levels L4/L5/S1 according to ADR surgeon, as my L4-L5 was degenerated - desiccated, concentric disc bulge, minor-to-moderate disc space loss - even though not a pain generator at that time. Some doctors even suggested a 2-level fusion, but I ended up having a one-level and taking my chances on the L4-L5.

After L5-S1 fusion, in general my leg pain was 95% better and lower back was 70% better. Both close to 100% w/o any activity. I was generally very happy.

After fusion recovery, I was back playing rec soccer and still occasionally play, although my back pain is steadily getting worse and takes a lot longer - now 5 years after - for "inflammatory" pain to subside. I have a desk job, so my lower back is typically not a big issue for day-to-day activities. However, even 30 minutes of yard work will bring on moderate pain that will take 2 days to "normalize". I take no medications.

Newest MRI shows further degradation of the L4-L5 and worsening Modic changes around that joint. CT scan confirmed years back that I am fused across L5-S1, so that should not be my issue. I always knew L4-L5 would take the brunt of my continued activity post fusion. But, I did hope it would survive a bit longer than 5 years. The rest of the spine is pristine.

Now I have 3 options. Do nothing until it gets worse, fuse L4-L5, or ADR L4-L5 assuming I am still a candidate. The only fear of ADR is potential prosthesis issues (i.e. wear, subsidence, dislodgement) and not being able to find a surgeon who would want to take the risk to remove. So, the ADR research starts again. Based on my prior good surgical experience w/fusion, I would fuse again in a heartbeat, but then I really would have to slow down activity in fear of ruining the rest of the spine....and even that may not be enough.