[henry4956]

What a dilemma. You will undoubtedly be haunted by this decision. My instincts say the M6 should come out, for what it's worth. Perhaps the docs who say it can stay in, are saying that because they are not up to the task of taking out the M6. Too many surgeons IMO make recommendations based on their limited abilities and instead of saying 'I think you should do X, and I'm not experienced or trained to do X, but I can recommend someone who can'

There's not much I can say or that anyone can say that is going to make this any easier for you to decide. Even as far as the fusion, I have a friend with multiple lumbar fusions who swears if he could do it all again - he would make sure he'd have nothing but '360' fusions, which of course require posterior and anterior approaches. I'm probably not helping you here. In my mind, I would not want anyone without adr experience taking it out but I would not want it replaced with another adr (say the ActivL) for instance. I do strongly believe the ActivL is a superior disk but in your case considering the level L5-S1, the existing condition Failed ADR, and some facet degeneration since original implant - I would think another 'replacement disk' would not give you much peace of mind.

However, I think you have said the level above is now showing signs of degeneration as well, in which case maybe the ActivL would be a better long term solution. An I have not even touched on the danger of going frontal again. Oh My God, this has to be the most complex decision I can imagine.

I think this one will require some deep consultation with the Lord. I think your answer will become clear eventually. Just keep the faith in the mean time and I for one will be praying for you.