[Tim]

Hi
Thanks for the replies.

I've now had 4 opinions - 2 from respected Uk surgeons via face to face consult and 2 from Germany (Dr B. and Dr Z.) via the interweb..
They all agree that that the L4/5 is the likely culprit (either through disc pain or through mechanical pain - mechanical stenosis has been mentioned).
Regarding the discogram there is general agreement that although the disc gave a technically negative pain response it did not give a negative dye distribution. It is pretty much impossible to get a +ve pain response from a disc that won't hold any pressure. Dr Z. claimed he managed to pressurize the L4/5 in 2003 prior to my surgery, but to me the images look identical to those taken recently when there was definitely no pressurization possible.. My recent discogram has definitely resulted in a delayed marked exacerbation of all my regular symptoms - my consultant seemed to regard this as relevant. However reference to a delayed response is not something I've come across in my research - anecdotal or otherwise..
My guess is that many surgeons would not even bother to perform a discogram on such an obviousy collapsed level - In an otherwise healthy spine the pain generator would be obvious. It is, I suppose, possible that the pain is coming from the 5/S1 but there is no obvious compression at that level. There is facet degeneneration present at both the lower levels but my symptoms don't clearly fit facet problems and the facet injections gave no relief.
Yes I have considered revisiting Germany and Dr Baumbach but feel I have to draw a line somewhere. Financially this is all crippling. Dr Z. seems to agree that tha L4/5 is the likely culprit so what more will Dr Baumbach be able to bring to the table. I'm trying to cross all the T's and dot all the I's but at some stage I will have to decide to jump or live with it.. If Dr's Baumbach and Z's services were free and they lived just down the road I'd be there tomorrow!
All 4 doctors have agreed that fusion is a sensible step but they all vary on the approach and instrumentation to achieve this. The choices seem to be Open PLIF + instrumentation, Anterior lateral transpsoas approach with plate, Open TLIF + instrumentation and minimally invasive TLIF + instrumentation. I'm concerned by the damage already done to my posterior structures during my extensive and pretty destructive decompression in 1988 so am leaning towards any option which minimizes further collateral damage.

Whether my logic is flawed on any of the above I really don't know - hence my posting..

Again many thanks for your replies.
All the best
Tim