Hi there, my issues are mainly at l5/s1, and imo this question is kind of a toss-up. From what I've gathered, if there is one level to have a fusion it's l5 s1. I know a couple people who've had it done at this level and they are fine. I think with this level, the question comes down to activity. If you are going to be doing light exercise and be moderately active, I think fusion is probably a good bet. If you want to get back to doing whatever you want, I'd probably lean toward ADR.
IMO, this level is kind of risky for ADR, since it doesn't have as much movement and has increased load. The facets are key here, and the more facet issues I run across, the more hesitant I am about ADR. This is a controversial topic for sure. If I was going ADR at this level, I would probably choose a very robust implant, and I'd definitely ask many surgeons for their opinion. TBI is a great place though, with great results.
In your case, you wouldn't have to worry about adjacent levels because your ADR will be on top, but you definitely need to be concerned about the shape of your facets.
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HIZ tear at l5 s1 with mild disc height reduction and mild dehydration.
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