[Paul C]

I wanted to update this post with a copy of the text from my MRI report. I think the radiologist was thorough.

If I had no other concerns besides addressing my back condition, I would be aggressively pursuing ADR overseas (likely 2 levels, but I'm not the surgeon).

Unfortunately, my present employment does not support the notion of ADR. Even if I were to pay for it out of pocket, it would medically disqualify me from my job which is, well, problematic.

My back pain can be hard to isolate, which makes it hard to describe and address. I have localized pain in the L4-S1 region for sure, and nearly always have pain in my quadratus lumborum, more severe on the right. My pain is sometimes localized to this region and, when it is, its manageable (though I have very little strength or stability with bending forward, which I have avoided for years).

Other times, I experience what I describe as tailbone pain, which is probably related to the sacroiliac joints. This is probably least common, and less worrisome than my other symptoms.

In the last six months, I have begun to experience pain that radiates throughout the entire mid-upper back, neck and shoulders, sometimes causing headaches as well. I had an x-ray of the c-spine which showed normal disc height. It is possible I am inducing these symptoms myself with my constantly-compensating posture.

Finally, I have recently begun to experience numbness and tingling in my legs and feet while sitting (driving). Often, I can push up with my hands and reduce weight on my spine and temporarily relieve this symptom. This is more pronounced on my right side, which I think corresponds with the diagnosis of severe foraminal narrowing on that side.

I would really like to hang on to my job for at least the next few years, so I have a couple questions for those who are more experienced.

1) Based on the report, does anyone think it is advisable to pursue foraminotomy, laminotomy or possibly microdiscectomy to alleviate the leg symptoms and possibly prevent permanent nerve damage? I recently spoke with an orthopedic spine surgeon who said these would only serve to reduce leg pain. Leg pain is not my prevailing symptom, but the tingling sensation is an increasing concern of mine. I would consider one of these surgeries only as a method of buying time to appropriately address the issue in a few years - and only if it would not preclude me being a candidate for ADR in the future.

2) I am aware that there is an argument that the L5-S1 level should always be fused when addressing DDD. I am not adverse to the notion of a hybrid surgery, and have heard many success stories about them. I may be able to arrange an ALIF for the L-5/S-1 and continue in my current job for now, and pursue ADR on the L-4/5 level in a few years, or possibly even many years if the fusion at L-5/S-1 addresses the majority of the symptoms. I think common sense dictates that one surgery is preferable to many, but does anyone see anything inherently problematic about this method of essentially "piecemeal-ing" a hybrid surgery?

My apologies for the extensive post, and to anyone who has read this far, I thank you. I honestly had no idea how many layers of complexity I would find when I finally got around to addressing my back issues, and I am incredibly grateful for the knowledge and advice shared on this site.

Best,
Paul