[annapurna]

David,
Look at the condition of your facets and other surrounding structures. What are the probable results of another year of improper loading on these? If you've got borderline facets, instability, discs with lots of height lost, then time may not be on your side. I'm really struggling right now with pain issues in the L5/S1 area three years post-ADR with facets or SI joints as the most probable pain generators. Both of these got severely overstressed during the many years I ran around on an L5/S1 disc that was <40% of normal height. Can I prove that the two are related? No, of course not. At the same time, I can tell you that facet/SI pain can be just as bad as discogenic pain and without the option of a prosthesis replacement -right now, anyway.

If I were you, I'd bring up the issue of damage to your posterior elements and surrounding structures with every surgeon you consult with. If things are already looking a bit borderline, then I wouldn't wait. Besides, as others have pointed out, do you really want to be someone's tenth or eleventh multi-level ADR case?

Best,
Laura