Some advice please
 

Hi all
Before I start I realize that this is not the place to come for medical opinion, although I do realize that some on this forum have done extensive research into lumbar pain. My concern is that I have read countless times that it is important to ensure where the pain is coming from, my pain is bending forward, movement etc, no pain when sitting or lying still, I have very rare sciatica down my left leg bit it is very very rare.

I have been diagnosed with DDD at L4-L5, L5-S1, you can see a picture of my most recent MRI attached,

the report of my MRI said as follows

L4-L5 moderate diffuse posterior bulge seen encroaching upon lateral recesses compromising the exit nerve roots bilaterally and equally
L5-S1 mild posterior disc bulge abutting the thecal with no neural compression
Intact shape and signal of the conus medullaris and filum terminal
Normal facet joints
No abnormal paraspinal soft tissue masses

The CT scan read as follows

Good alignment, Preserved lumbar curve, maintained disc spaces, no spinal stenosis

My own surgeon here in Dubai has suggested either hybrid fusion / ADR or ADR 2 levels, or Fusion 2 levels, he has carried out a provocative discography and informed that that both discs are the pain generators and he rates the L5-S1 disc as a 5D on the Dallas scale, when I asked him about the L4-L5 classification his words were ‘Almost similar because of Modic changes’ …………..(yes he is a man of few words), you can see attached the pictures form my provocative discography.

I have had initial opinions from Dr Clavell, Ritter Lang, Dr Rischke & Bertagnoli who all say I am a candidate for 2 level ADR, as I’m sure you all know they use various discs, thing is though these are all initial opinions that don’t seem to delve too much into your history etc., for obvious reason these Dr’s cannot spend too much time on these free opinions which I understand.

I got a opinions from Bupa based on my medical records that were sent anonymously to surgeons who are paid to simply provide opinion with zero self-gain, they all said avoid surgery, this makes me wonder if asking ADR specialists to provide opinion on my back is like asking Turkeys to vote for Christmas!!

I have asked my surgeon would it be worthwhile to have fact block injections to rule out the facets as the pain generators but he said it is only worthwhile if I have pain in retroflexion (bending backwards) which I don’t, I note the MRI shows ‘normal fact joints’, can I therefore assume my facet joints aren’t the pain generator?

Anyway I realise I am asking a lot but I would like you guys thoughts on the above if possible, am I a good candidate for ADR?

People turn to ADR surgery because their condition has got very bad and is significantly affecting their lifestyle but do not want to choose fusion. Ultimately however, as the disc(s) wear out there is a point where ADR is no longer an option. You'll know when you get towards the end of the road.

If your back is just hurting and you have some sciatica there is a lot you can do by going to a gym and building your core, back and abdominals and avoiding any heavy weight bearing exercise. In addition working on your flexibility (yoga, Pilates, stretching) will go a long way in addressing the sciatica.

Unless the degenerative condition of your disc(s) is within a grade III categorisation *and* you are experiencing significant symptoms, you should be focussing on conservative treatment if you have not done so already.

Personally I found the nerve root injections did nothing for me, decompression surgery did nothing and effectively put me back. Ultimately I was able to continue for a few years with significant improvement after focussing on core strength training and flexibility over a period of 12 months. After a few years passed things turned for the worse and earlier this year I had to consider if I was prepared for fusion if ADR was not an option. I also had to pay for the treatment out of my own pocket as I had a pre-existing condition and this treatment was not available on the British NHS.

Prior to seeing my consultant who perform d the surgery previous advice was leave it until you need to fuse the vertebrae. The advice I received was from consultants who did not perform ADR surgery and whose only encounter with artificial discs was in removing older failed mechanical devices and hinges.