@cabits Hello. I am a cervical spine surgery patient and I understand your dilemma. In my experience, a neurologist and a spine surgeon will look at imaging differently. They both see the structural issues, but they think about it differently. I had my surgery at Mayo, and the surgeon had me see a neurologist first who said he wasn't sure if it was bad enough for surgery yet, but that the surgeon might have a different opinion. That was true, and the surgeon offered surgery which I gratefully accepted. What you also need to take into consideration is how much nerve or spinal cord damage is happening, and when would that become permanent? That is a hard question to answer, and I was told that myelopathy (spinal cord damage) doesn't always show up on the MRI. When myelopathy does show up as a whitish area inside the spinal cord it is because the axons of the nerve bundles have died off and dissolved in the spinal fluid.

Put these questions to your surgeon of how urgent is your need for intervention and what are the risks of waiting. Surgery will stop it from getting worse, but it doesn't heal permanent damage, and you could end up in pain even though you have had surgery. If you have spinal cord compression as I did, it is better to decompress that before real damage happens. I had my surgery at 59 and had a great recovery and it did relieve my pain because it was caused by spinal cord compression.

It is your choice when to proceed and which surgeon you hire for the job. Get as many opinions as you need to make an educated choice. There are differences in what implants may be used. I chose only a donor bone graft and no hardware for my one level fusion. That was offered by my surgeon because I agreed to stay in a neck brace until fused (3 months) and that was worth it. He probably would not have offered if it was a multilevel fusion. Lumbar surgery is a much more difficult recovery because it is bearing most of your body weight. What also matters a lot in recovery is if you can get onboard and embrace the journey. That will help lower stress and reduce pain and you will heal better. You have to pick a surgeon you believe in and for whom you have total trust. You need to be comfortable with your surgeon and have all your questions answered. I was in pain for 2 years as I went from surgeon to surgeon and could not find one willing to help me until I came to Mayo. That was because the non-Mayo surgeons did not understand how to connect my all over body pain symptoms to the spinal cord compression in my neck. I would have had my surgery a lot sooner if I could have. I did loose muscle mass in my arms and shoulders because of waiting, and I got muscle back after my recovery, but not all of it. I am not quite as strong as I was before, but close. Taking pain meds might mask some of the dangers. I didn't take pain meds before or after my surgery which worked for me, and I also could chart my progress.

It will be a long recovery. I am so glad I had this surgery. You might enjoy my patient story.
https://sharing.mayoclinic.org/2019/01/09/using-the-art-of-medicine-to-overcome-fear-of-surgery/
Would it help you to get a few other surgical opinions?

@cabits thank you for posting with interest in connecting with others as you go through this decision making process for yourself. As @jenniferhunter mentioned in her response she so carefully crafted for you, having gone through spine surgery herself, "It is your choice when to proceed and which surgeon you hire for the job."

I will let you process all of the information she has shared with you and consider her question on if you might wish to consider other opinions for your case.