You currently have “fibrosis within the right 1.3-4 neural foramen with tiny, nonenhancing, disc herniation in combination with postoperative fibrosis impinging upon the exiting right 1.3 nerve root sheath”
That with the right sided symptoms and the comment “noted there is almost no good disc there following a previous microdiscectomy + discitis. The levels were almost bone on bone” along with no significant findings at other levels leads me to believe that this L3-4 level is the pain generator. I agree that an ADR is not appropriate and that a TLIF or OLIF type fusion is the way to go.
Just to make sure, I would use a diagnostic SNRB block at right L3-4 then keep a pain diary to see if the symptoms temporarily clear.
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.