Just a couple of points, Matt.
1. How little disc height do you have left at L5-S1? Most discs are usually about 10mm.
2. Have you had a discogram? The reason I ask is that sometimes a very badly degenerated disc may not be causing much pain, but rather the pain may be caused by some of the lesser degenerated discs at levels above.
3. If the discs above are causing the pain, one solution could be a hybrid procedure with fusion at L5-S1 and then ADR at L4-5 and/or L3-4.
4. You can fairly reliably tell if the facets are causing pain right now by having medial bundle branch blocks with anesthetic done under x-ray guidance. This will not ultimately determine if you will have issues post-op but will give some guidance. Unfortunately, the correlation between xrays and facetogenic pain is quite poor.
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Pain since 1990, severe since 2008
MRI 03/08 showed L5/S1 severe dessication, L4/5 moderate disc bulge with annular tear. Some facet arthritis at L5/S1 and L4/5.
50% pain relief with RF neurotomy for left L4/5 and L5/S1 facets 07/08
Pain worsened 12/08
Discogram 03/09 with no pain at L5/S1, concordant pain at L4/5, severe but not usual pain at L3/4
ADR with aMav discs L4/5 and L5/S1 02/10
Recurrent pain 05/10
Current plan to try pilates
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