Jeff,
Thanks a lot for your reply. I'm relieved to hear your opinion about the integrity of my fusion. Each day that passes I'm a little more confident that you are correct. I would imagine I'd have to do something extremely violent to my back to destroy a 20 year old fusion, and Mckenzie exercises probably do not qualify.
You know how it is when panic sets in, though.
I've read, and had it confirmed to me by my PT, that mild foraminal narrowing and mild facet hypertrophy happens to many people as a natural consequence of aging and are often asymptomatic. Upon reviewing my MRIs, I do not recall my ortho surgeon indicating foraminal narrowing was compressing nerves. However, I take your point, and that's why I must insist that my doctors help me confirm what the pain generators are. Perhaps a new MRI will reveal more narrowing (I hope not).
Do you think the broad-based central disk herniation impinging upon the ventral thecal sac alone can cause sciatica?
Thank you for mentioning a discogram and/or an epidural steroid injection as methods to determine if the disc is a pain generator. I will ask my ortho surgeon about them tomorrow.
I understand it's hard to know when to pull the surgery trigger. I suppose if I do not improve (or if I worsen) within a year of PT and other conservative methods, I will very seriously consider surgery. My fusion wasn't only about relieving pain; it was about preventing further damage. I plan to take the same preventive approach at the L4-5 level, but I do not want to rush into it prematurely.
ADR revision seems to be a very big concern for people in this community and rightfully so.
Am I correct in assuming there really isn't a lumbar ADR in existence yet which wouldn't be terribly traumatic to revise if necessary?
The other thing I was wondering is
would a minimally invasive partial microdiscectomy to remove the part of the disc pressing on the nerve, and a foraminotomy to widen the foraminal openings (if necessary), be indicated for a patient with DDD? Or, would that just weaken the disc thereby speeding up the compression and damage?
Thanks again,
James (zenmunk)