to operate or not

Ok so I went for a lumbar discectomy 8 years ago after a massive disc rupture (approx 75% of the disc was removed) in my L4/L5 disc.  Recovered fantastically well & all was well for about 5 years.  Gradually the pain returned, & it felt like I had a number of smaller disc events as I had the same (but much milder) symptoms I experienced with the original event.
Even going to the chiropractor only offered temporary relief & it often felt as though my back was "seizing up", & I was taking Diclofenac on a daily basis, just to keep moving like someone in their early 30's rather than looking like someone in their 60's.  Often I cannot sit up from lying flat on my back (need to roll over & then get up, sometimes from all fours on the floor), I am unable to sleep on my stomach unless without pillows of any kind, but it still hurts if I sleep on my stomach, even without pillows.  
Last year I saw a neurosurgeon in South Africa & he recommended a disc replacement, but as a temporary measure (due to financial constraints) I was given a facet block by a partner of his, a radiographer.
This is what the radiographer wrote in his report:
Gas is noted in the disc material.  Spondylosis is evident at the L4/L5 level with early posterior osteopathy formation noted as well.  A  minimal retrolisthesis is present.
As there is so little of the disc left the neurosurgeon felt disc replacement was advised to keep mobility in the area as my spine is very straight in that area (no curve as there should be possibly resulting from an injury at the age of 12 involving falling 20ft in a sitting positionvfrom a tree & landing with my coccyx on a stone at the base of the tree).
2 years prior to this facet block procedure my chiropractor had noted L4/L5 & L5/S1 disc space narrowing with degenerative endplate changes, but spondylosis was then not present.
As my original surgery was so successful I am not worried about another operation, but will a surgeon be willing to operate?

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

I understand your concern. There is a condition called failed back surgery, but it typically occurs in people who do not have “real pathology” prior to surgery. It sounds like you had a significant disc herniation/rupture. Other causes of failed back surgery include inadequate removal of all of the herniated/rupture disc, postoperative inflammation/scarring, surgery at the wrong spinal level, muscle spasm, and psychosocial issues that have not been addressed. Treatment options include redo operation, chronic pain intervention, rehabilitation, and/or neuropathic medications.

I cannot answer whether a surgeon will operate or not.  I would discuss your concerns with a surgeon. I would recommend that you exhaust medical treatment and physical therapy prior to having surgery. The indications for urgent surgery are evidence that a nerve is being compressed on to the point that its function is impaired. These symptoms include muscle weakness, loss of bowel or bladder control, loss of sensation, particularly in the pelvis and severe and progressive pain.

I highly recommend that you discuss your concerns with an orthopedic surgeon or neurosurgeon.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.