The spine and its mysteries seem so capricious! I will be 83 tomorrow and am 2 weeks post-op from an L4-L5 laminectomy, which resolved ALL of my symptoms. Fifteen years ago I was told by an orthopedic surgeon that I needed a spinal fusion for Grade-1 Spondylolistheses at L3-L4 and L4-L5, having experienced recurring episodes of LBP (lower back pain) over the previous 20 years. I refused, and he said, "You'll be back when you're in enough pain!"
That day occurred a year ago, when I experienced sudden acute pain in my entire pelvis, with sensations of hot pokers radiating through my hips and into my buttocks and hamstrings (evolving eventually to include episodes of leg weakness and foot numbness). It should be noted that I had comparatively little LBP with this, which became an important distinction for eventual diagnosis, as I later learned. The most recent (of several, over the years) MRI report described "Central canal" Lumbar Stenosis (another important distinction, from Foraminal stenosis) with "severe compression of the Thecal Sac and Cauda Aquina" in that L4-L5 segment, as well as a spontaneously-occurring fusion of L5-S1 vertebrae.
I was able to continue functioning with copious use of OTC NSAIDS, until I saw an Orthopedist who told me I needed spinal fusion, because injections and even laminectomy would not help at this point. I was spurred into action when he told me that I should go to an ER for emergency surgery if I experienced sudden loss of bladder/bowel control and difficulty walking, i.e., Cauda Aquina Syndrome (CES). Determined to never be dependent on ER spinal surgery (Ewww!), I met with a local neurosurgeon I had previously seen (without benefit) for cervical neuropathy. He recommended interbody (TLIF/PLIF) fusions of L2-L5. (I knew few of these words or acronyms a year ago but am an obsessive researcher by nature!) After much reading and YouTube videos, I sought a second opinion at Mayo Clinic-Phoenix, 6 hours from home, which miraculously accepted my Medicare Advantage plan (one of only 2 MA plans they do accept, I was told).
After sending many recent supporting notes and imaging reports, I met with my assigned Neurosurgery Dept evaluator, Dr. Lyons. He told me that I might "indefinitely" (or not, as I have learned from MC Connect!) benefit from non-invasive treatments like repeated corticosteroid injections, etc. He reassured me that CES was slow to progress and certainly not imminent, and that multi-level fusion did not appear to be presently necessary (Phew!). He opined that I would likely benefit from lumbar decompression without fusion, as X-Rays revealed minimal instability of the 2 spondylolistheses, and that my osteopenia would not be a deterrent without the need for fusion hardware. He stated that Laminectomy was more likely to address buttock/leg pain, but less so for LBP.
He advised that the need for eventual fusion was possible due to future osteoarthritic bone growth, but that my general good health and recent pursuit of core-strenghtening exercise would be of benefit in any case. Considering my advancing age, it seemed to me that future eventualities were insignificant and that avoiding a multilevel fusion was paramount, and I agreed on the spot to proceed with laminectomy surgery.
When I awoke in the recovery room, I knew immediately that the surgery was successful in eliminating all of the symptoms that had plagued me for the past year. I am currently delighted that my current LBP appears to be limited to post-surgical wound pain and (familiar) general muscle soreness and weakness.
I apologize for the length and detail of my reply, but this is my first and likely only comment after lurking and learning on Connect for many months. I recall how difficult it has been to find and piece together those bits of info that have been specific to my own issues. I have tried here to be as informative as possible to those beginning this journey, and to illustrate the immense diversity and individually of presenting issues and complications that must be considered by each traveler. And I confess, I have created my own start-to-finish (for now!) personal Journal, to organize and document my own 'trip' for later recall. Blessings and best wishes to all of you on this path, and my eternal gratitude to the Mayo brothers for creating a truly patient-centered Haven of Healing!