Thanks for reading all of this in advance. I'll start out by saying I am in shape, muscularly very strong, do weights, yoga, swim etc., don't smoke and only drink socially.
I am looking for some insight and thoughts on the next best move for me...laminectomy vs. fusion.
Two surgeons have warned me that a lam. will likely require a follow up in 5-10+ years to deal with further disc degeneration. Both have said this is required as a minimum.
One surgeon suggested fusion "now rather than later" since I do have some disc degeneration/thinning and a lam. won't address instability. I have no gross instability, but may have micro-instability (see below). He has said since my problem is S1-L5 that a disc replacement is not the best idea.
My physiatrist warned me that post-operative chronic pain was more likely following a fusion than a lam. (about 50%, versus about 15%). Not a fun prospect.
I think this frames the question: "Since stability points to fusion, is there any way that micro-instability can be assessed?" Since my initial flare up, I have often felt my lumbar/sacrum was "weak" or my hips were "unstable." I've never been sure if this was due to muscular tiredness due to other weakness/compensation or if I am (slightly) mechanically unstable. Which came first? Chicken or the egg?
Here's the executive summary:
23 months ago - searing white hot pain in lumbar/sacrum - no motion or initiating activity. Pain management worked. Chiropractic was "the old fashioned way" and did not work and on 2-3 occaisions made it worse. MRI nothing special to distinguish me from my peer group, some mild disc bulge, some mild stenosis.
4 months ago - sitting down...searing pain, body felt heavy on my back. Could only shuffle 6 inches at a time, with support. Only comfortable position was laying on my side. Had left leg drag a couple of days after, but didn't know how serious it was. Cleared up spontaneously in 3-4 days. MRI was same as before...perhaps a slight increase in herniation? Difficult for even the radiologist to be definitive.
3 rounds of epidurals - helped the pain.
1 month ago - left leg drag. Medrol dose pack, cleared up well in 1 day, 99% in 3 days. Surgical consult ordered - No need for surgery now...but be prepared in the future.
Last week - left leg drag, much worse than before. Bad enough to get an immediate consult with a surgeon and MRI. MRI showed maybe a 1mm increase in my hernaiated disc, putting pressure on the RL nerves, and a facet (?) putting pressure on my LL nerve. My physiatrist warned me that surgery was not being pro-active, it was reacting earlier, rather than later to an emergency situation "You need something done, sooner."