This is not so much a request for help or answers (but maybe someone has some thoughts) as a rant. I had L5/S1 disc/lami on the left side in 2009. A bulge on the left was noted but not corrected.
I started to get some other issues last year which appeared to be SI joint, MRI showed same bulge, same disc appearance, no nerve impingement etc., I recently had an RFA on my R SI joint. It didn't really help, or maybe it did and just uncovered a different pain source.
Shortly afterwards the RFA, I developed a *nasty*, hacking deep, cough bad enough that I would "scream" as my body convulsed (my GP gave me some high potency cough suprressant with codeine I think - it helped, but not enough). The pain would extend down my leg to my knee. A physiatrist my pain doc referred me to, said my bulge was not insignificant, but she felt the problem was the disc and said I should try to work with a spine PT. She also suggested a round of epidurals to calm things down.
Today I had my first epidural, it certainley helped, they always did for about 3 weeks. What has made me concerned is my pain doc asked if I had gone to get a consult from my N-surgeon and said he felt they were both "very conservative" (I agree) but the pressure build up on coughing can cause general nastiness in joints which had some degeneration (mine) and which had not been fused.
So now I have gone from pre-cough of annoying with a 2-4 pain range to, this hurts 2-6 (but typically 4-6) with me willingly taking tramadol. Now my conservative pain doc is asking if I have gone to get a surgical consult.
I've observed a fusion in the OR and it ain't pretty. It seems the odds of a positive outcome of a fusion is 60:40 rather than the 90:10 of a disc/lami. I'm not at the point where I want to play those odds, but at the same time, I am in discomfort to active pain most of the time now.