am a 61 year old slim agile female who has had serious degenerative bulging disk disease at L4-L5 for two years. Had laminectomy - disectomy in August 07. No help. Multitudes of steroid shots - radiofrequency lesioning - braces - hot - cold - pain meds - PT - nothing has helped. Main pain is in my mid lower back left SI joint (starting now on right side). I am a legal secretary and sit all day which aggravates tremendously. My doctor here in Jonesboro, Arkansas has only started doing ADR's and has done 18 to date. Says I am a good candidate. My thoughts naturally are "What again - what if this doesn't work either?" I have so many questions before I actually make my decision - but it has to be this year because of my age. I have never entered a forum but I joined yours yesterday under this e-mail address and my name PolliBibbs. I don't know exactly how to find someone on the forum to talk to about this specific or even how to talk to them. Can you help me please?

Glad you found this forum, but please do your homework. I think there's a cut-off with ADR for people over 60 according to Medi-Caid or such. There's a post about it here on the forum. You should be able to find it with a search. I could be wrong.

I'm also confused that if you have SI joint pain, then how do you/your doctor assume ADR at L4L5 will help that pain?

What is the success rate of ADR with your surgeon? How many years has he been performing this surgery and what tests does he perform to determine who is/isn't a good candidate? I was a good candidate according to my surgeon, but turns out he doesn't really test people. Instead he just looks at an MRI. That's not nearly enough to determine a good candidate.

I suggest being aggressive while pursing a excellent surgeon and ask him/her many questions before you make your decision. A fusion at your age won't really hinder you. An excellent physical therapist will make or break your surgery, regardless of what surgery you undergo.

Just want to clarify that the age limit was set by Medicare and does not necessarily prevent you from having an ADR. Otherwise, I would agree with Zorro about doing your homework and consulting with surgeons with more experience. At the very least, your bone density should be checked to rule out osteoporosis.

My doctor's cut off is 60 so he says I have to have it done this year if I have it done. Have had density done and it was fine. I am scheduled for a discogram next week. I too am concerned though that most of the pain is in the nobby protrusion (which I call the SI joint - I could be wrong as to that being the SI joint)which is to the left and right of the bottom of the spine. I do have low pain in the spine too. I am a legal secretary and sitting simply aggravates.

do the discogram and also test the facet joints. look for minor or moderate facet wear. If it's moderate or more I would really hesitate pursuing ADR. Make sure to get a lumbar MRI.

the SI joint is located here;

http://www.eorthopod.com/images/Cont...t_causes01.jpg

Lumbar MRI in May said : Circumferential disc bulging with facet joint arthropathy. There is moderately severe bilateral neural foraminal stenosis present with impingment onboth L4 nerve roots.

I had laminectomy/discectomy done in August 07 - no help. Physical therapy - no help. Last Thurday had a huge steroid shot right in that joint (I still can't tell on the picture if this is what I am talking about. My main pain is in the boney protrusions on each side down right below the waist. The pain management doctor - the neurologist and the neurosurgeon all act like that is just part of the disk problem. But I just don't know. No one has ever talked about doing a scan or an MRI of that particular area. Thanks for talking with me about this. How are you and what was your problem and procedure? Polli pbibbs@snellgrovefirm.com

Zorro, nice post -- and very good points indeed!

Polli, Zorro has raised several really serious considerations here. Facet arthrosis is a big concern for patients seeking an ADR solution, and it should be; as some patients continue to have facet disease/pain after surgery. For some folks with facet issues, motion preservation may be risky, and fusion may be a far better option. The missing factor in these cases is the cause(s) of the disease process.

Also, SI joint issues are very complex, and it's tough to troubleshoot the exact cause. Finally, arthritis may be a systemic issue that affects MANY joints. If that's not enough, arthritis can be brought on by multiple factors!

I hope this helps more than confuses, let us know what you think about all this...

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