@lioness2001 @pat75 I was interested in the article you posted, and by searching for the title, I found the full article at this link. https://www.nejm.org/doi/full/10.1056/NEJMoa1513721

With any clinical trial, it is important to look at the exclusion criteria because if a patient has those criteria, the results of the study may not apply to them. As patients, we are often biased and look for the easy way out, an answer that avoids going through surgery. Sometimes that approach is correct, as surgery should be the last resort, but we do have to ask if the results of the study we found actually apply to our situation. I kept looking for details in the study on the methods of how decompression surgery was done alone without a fusion, and I didn't find it. If a fusion is done, it is because a disc is removed and the vertebrae are fused together with a bone graft or cage seeded with bone to fill the space.

The exclusion criteria are shown in table #1 and include scoliosis (Cobb angle measurement that measures side bend of spine), spondylolisthesis (slipping of one vertebra past another), instability or a herniated disc. A herniated disc is a common cause of spinal stenosis in the central canal. I am a spine surgery patient, and that happened to me in my neck. The jelly like nucleus gets squished out of the ruptured disc and causes inflammation which it turn generates bone growth that tries to stabilize the spine. This caused bone spurs to grow next to my herniation, and 9 months later, those bone spurs had doubled and filled in on the other side of the disc protrusion. All of that was pressing into my spinal cord, and the only way to decompress that was surgery, and the surgeon had to access the central canal by removing the bad disc. The disc height had collapsed by 50% and I lost a quarter inch of my standing height. All of this spine degeneration had progressed while I was in physical therapy for thoracic outlet syndrome which is a compression syndrome of nerve bundles and blood vessels passing through the chest and shoulder. My therapy did also involve trying to relieve neck tightness and spasms and to try to maintain a normal spine curvature. Physical therapy did help buy some time before surgery, and for 2 years, I wasn't able to find a surgeon willing to help me. I probably would have been much worse off without PT. After 5 surgeons turned me down, I came to Mayo, and had decompression surgery with a spinal fusion at C5/C6. That was 5 years ago, and I do not have any adjacent segment disease.

I also have the book that was mentioned by David Hanscom M.D. called "Back in Control". It is excellent, and he is a spine surgeon who makes the case that too many unnecessary back surgeries are done. One thing to realize is that fear increases pain a lot, and as patients worry about needing surgery they likely increase their pain because of their fear. He gives some ways to try to reduce anxiety by writing down your fear, and throwing that note away. He also mentions myofascial release physical therapy, and I had been doing that with my physical therapist for many years. MFR gets the body moving by releasing overly tight tissues with a gentle stretch, and can relieve pain by removing restrictions. MFR helped add to the success of my fusion and the recovery.

Here is our discussion of Myofascial Release therapy. https://connect.mayoclinic.org/discussion/myofascial-release-therapy-mfr-for-treating-compression-and-pain/

You can find information from Dr. Hanscom here. https://backincontrol.com/

Dr. Hanscom talks about calming your fears and rewiring your brain, and that is exactly what I did in those 2 years leading up to my spine surgery as I worked through and addressed my overwhelming fear. By the time I got to my surgery, I had conquered the fear and went calmly into my future.

It's important to realize that you can overcome your fears if you want to make the effort. Doing that will free you from it for the rest of your life. It certainly helps to learn all you can about your condition and understand how treatment or surgery can help, as well as understand how to minimize the surgical risks. You need to understand what your future will likely be if you do nothing, do therapy instead, and how you can change your destiny in the choices that you make. Remember that you are lucky to have choices, and those choices can possibly help avoid a disability in the future. When you realize that you are making the choices, it takes some of the stress out of those feelings of being trapped by a diagnosis and a recommended surgery. When it becomes clear that surgery will give you a valuable benefit, don't say to yourself that you have no choice except surgery. It may be the only good choice, and it is still a choice with a willing provider. It was my only good choice because I was loosing the coordination of my arms and was at risk of paralysis if there was an accident or a fall. I am grateful for the surgery that gave me back the use of my arms. This is my story.
https://sharing.mayoclinic.org/2019/01/09/using-the-art-of-medicine-to-overcome-fear-of-surgery/