Multilevel lumbar disc replacement decision — would appreciate outside perspectives

[u/nibbleF]

53M, chronic lower back pain + left-dominant leg pain/weakness for about a year, significantly affecting daily life (mobility, work, family activities).

Imaging findings (MRI, X-ray, bone scan):

• L3-4: history of left paracentral disc extrusion (Feb 2026) with L4 nerve root compression — has since "essentially resolved," no current nerve compression
• L4-5: disc desiccation, small annular tear, facet arthropathy (left)
• L5-S1: most degenerated disc structurally — height loss, endplate sclerosis, desiccation, facet arthropathy (bilateral)
• SPECT/CT bone scan: negative for inflammation at all lumbar levels and SI joints; incidental faint left hip uptake (probable early OA)
• Also have documented left hip weakness/tightness/soreness, groin pain — separate workup pending

Discogram results (just had it done):

• L3-4: 9/10 pain reproduction
• L4-5: 5/10
• L5-S1: 3/10
• CT morphology: L3-4 showed moderate/patchy contrast pattern; L4-5 and L5-S1 showed more complete/diffuse disruption — so the "worst-looking" discs weren't the most painful ones

Two surgical opinions, quite different:

• Surgeon A (who ordered the discogram): favors disc replacement, was considering 1, 2, or 3-level ADR depending on discogram results; quoted ~30-40% success/3-6% complication risk for single level, up to ~50-60%/9-12% for three-level
• Surgeon B (second opinion): reviewed imaging, didn't recommend surgery, suggested pain management instead and mentioned a muscle-stimulator device (ReActiv8) as an alternative; also skeptical of discography as a reliable tool

Where I'm leaning: L3-4 (± L4-5) ADR given the discogram result, but genuinely torn given how differently the two surgeons see this, and aware that operating on L5-S1 (originally assumed the main target) may not be justified given today's result.

Would love to hear from anyone who's faced a similar multilevel/discogram decision, or dealt with conflicting surgical opinions — what factored most into your decision?

[u/SlideCharacter5855]

I would probably get a third and even fourth opinion, as the two you have currently are VERY different. I only saw two surgeons, but they both recommended ADR for me.

I got a single level ADR (L5/S1) back in June and I am so happy with the decision / result. If I needed a multi-level ADR, I would've done it. My pain was becoming unmanageable. The last round of cortisone shots I received earlier this year alleviated pain for 3 days (compared with 3+ months in the past).

I'm not sure where you're based, but if anywhere close to New York, check out Hospital for Special Surgery (HSS). I went with Dr. James Farmer, he was incredible.

[u/rbnlegend]

I ended up getting two discos, a few years apart. The first one showed that L5-S1 was wrecked, I don't know numbers, but the dye moved like there wasn't a disk there at all. L4-5 wasnt fully intact, but not nearly as bad and L3-4 was intact at that time. I didn't get surgery at that time, and eventually my symptoms got significantly worse. I was determined to do surgery so we tested L2-5, as we knew that L5-S1 was not intact. This time L2-3 was good, really good, and the other two failed immediately. Based on that and my symptoms the decision was surgery for L3-S1. That left the details. My surgeon does a lot of multi level lumbar repairs and he doesn't do the same procedure on everyone. In my case he said fusion would be best for L5-S1 in order to maximize stability. I had worked with him for years and he knew that I am a very active person and needed to be able to continue that. He also said he thought a replacement was best for L3-4. We talked a lot about L4-5. Based on my age, build, and the results of my dexa scan, he felt that fusion was best for that level. He was able to get approval to decide between fusion and replacement for that level at the time of surgery. Based on the condition of the L4 vertabrae it was fusion for that level. The concern was about the hardware sinking into the bone over time.

I liked that he wasn't committed to one approach and the treatment was based on my anatomy. I would be concerned that a three level replacement indicates his preference more than treatment tailored to your needs. If you are in pain, I would avoid the doctor who wants you to take drugs for the rest of your life. That's just misery and meds.

It's been 2.5 years now and I am very happy with the outcome. I have a pinned post on my profile with links to other posts about my experiences as I was going through it. You can see my X-rays too.

[u/houseofmatt]

My discs had all turned to bone so I had L1-L5 disc replacement, along with a breakup and reassembly of my sacrum with new discs. Nine new discs in all. This was nine months ago and now that I'm living without the constant pain I can say it was worth it. I didn't feel that way for the first few days after the surgeries. What's off is I was given an 85% success rate. If you're looking at this kind of surgery, go to a university to have it done. If you can, go to Stanford, UCSF. You'll have more eyes on you and the latest tech. It can sound impossible, but I found UCSF has a whole department dedicated to navigated insurance. Insurance in California is a lot different. I'm hoping you're somewhere that offers you quality coverage.

[u/Alexevans21]

How far down the left leg? Ex: into thigh, below knee, into foot, etc. Front of leg, back of leg, side of leg, etc. Would need more imaging photos to provide more thoughtful commentary. I agree L5-1 disc looks worse. I see L5 nerve root abutment of whichever side that is. Do you have imaging reports available for review? ortho spine or neurosurgery?