[Jim M2]

I had L5S1 Charite in 2003 that could have caused facet and SI joint problems with some pretty high pain levels which I've dealt with for the past 10 years. In addition to the L5S1 facets and SI, I now suspect L4-5 discogenic pain that on some days has driven me home from work early so I could lay down. In addition I have pretty bad cervical and T-spine pain sources. If I lose my ability to work I think that will be the start of a death spiral. The only hope I can see is to roll the dice on surgery.

Lumbar
I'm thinking an L5S1 revision to fusion and L4-5 fusion if both levels can be done together. This may not be possible simply because I can't imagine a really good surgeon wanting to take on a revision. Why should they want to deal with it when they have a long list of patients who they can help with a much higher percentage of success.

Cervical-thoraic
Probably a multi-level fusion would be my choice if I can't find a lower risk treatment. I'm gun-shy about trying ADR again given my lumbar experience.

The goal is to get well enough to stay at work so I don't start a downward spiral. I would go for heavier medications but the PMs seem hesitant to help me in that respect. Any feedback would be appreciated.