@jenatsky I appreciate your thoughts on this.

@jenniferhunter I appreciate your comments too!

Having "extensive" surgery on my lumbar spine has been hanging over me for 6 years. I was 62 years old at the time and I was still recovering from bilateral knee replacements and microvascular decompression surgery (MVD) for trigeminal neuralgia. Things were going reasonably well when I suddenly developed radicular leg pain with acute onset foot drop. I was dragging my right leg and I was in extreme pain.

An emergency MRI was done. The MRI showed severe spinal stenosis along with multi level disc bulging, facet hypertrophy and other problems.

Due to 12 years of moderately high dose prednisone to treat PMR and inflammatory arthritis, I wasn't the best candidate for a multi level lumbar fusion. Fortunately, a large dose of prednisone relieved the pain but all the damage remained. I got two opinions about going ahead with surgery but the consensus was that pain should be the determining factor about whether or not to actually do the surgery.

I'm probably a better surgical candidate than I was 6 years ago. I'm being treated with a biologic that works and I have been off prednisone for the past 3 years. My pain level is still tolerable but I still have considerable nerve damage. My present neurosurgeon thinks I'm downplaying the pain. I have chronic foot drop and some other muscle groups in my legs have no innervation. My paraspinal muscles have atrophied so that is the latest concern.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8479522/#:~:text=The%20muscles%20surrounding%20and%20attaching,the%20spine%20and%20whole%20body.
I admit to being fearful about doing surgery but mostly I think surgery won't do any good. My knee replacement surgeries were complicated by extensive heterotopic ossification and I was told that I should never have another surgery.

My current neurosurgeon thinks just a L4-5 fusion will do the most good. I'm tempted to do a single level fusion but not my whole lumbar spine. I will be getting another bone scan, x-rays, EMG and MRI in preparation for a L4-5 fusion. If things are progressively worse, I will probably do the L4-5 fusion sometime this year or next.