Susan,
You're already seeing a neurosurgeon at Mayo and I don't know how hard it is to change there but I would suggest asking for a second opinion at the clinic if he isn't willing to do discuss surgery. They do want you to jump through all the hoops but at some point you may have to say all of the alternative therapies are not working and you want surgery. Take records if you have them to support your position.

@wil24 Hi Susan. Thank you for reaching out. It is actually a good thing that you are not being rushed into surgery. Perhaps your surgeon wanted to exhaust all options first before proceeding to surgery. I'm guessing that your follow up at Mayo will be with this new MRI and to discuss the findings and changes since the prior imaging?

When I came to Mayo and saw Dr. Fogelson, I had been dismissed by 5 locals surgeons who just didn't understand how my symptoms were related to my imaging. I spent 2 years trying to get help locally and worrying about having permanent damage and they wouldn't offer to help. I also would not want a surgeon guessing if they didn't understand the problem. Sometimes, you just need to get several opinions before finding the right surgeon with a good plan of care. This is my surgeon at Mayo, and he is excellent at his techniques and at helping patients feel at ease.
https://www.mayoclinic.org/biographies/fogelson-jeremy-l-m-d/bio-20055624
You don't have to agree to do spine injections or take pain medications. Those are your choices as a patient, and it may be that your insurance company wants to see this as justification that surgery is necessary. When PT fails to improve your condition, it also says that surgery may be needed. I know it is frustrating. Problems with legs do happen with cervical spine issues with spinal cord compression. There may also be lumbar spine issues contributing to leg pain, but in my case, there was not a lumbar issue, and leg pain was generated only by the cervical area due to stenosis in the central canal. That was the symptom I had that confused so many surgeons before I got to Mayo. That is called "funicular" or referred pain.

What you can do to make the most of your appointment is to write a list of questions that you have. The motto at Mayo is "the needs of the patient come first", so your surgeon should listen to your concerns. Make sure you ask direct questions because they don't know what you are thinking unless you tell them. It is always worth asking how your condition will progress without surgery and how fast, and if and when permanent damage occurs. That may be very hard to answer. If your surgeon knows that you want to fix this with surgery and will follow advice, they may be more willing to listen. Every case is different and the surgeon has to qualify you for a procedure and consider other diagnoses that could be confused with spine symptoms to make sure to cover all the possibilities.

When you have spinal fusions, it usually increases the chances of the levels adjacent to the fusion developing damage from the increased stress on them, so that may be a reason the surgeon is waiting. Adjacent segment problems do also happen after artificial disc replacements, and to patients who have not had any spine surgeries. It may be that the risks are a bit higher with fusions. There is a right time to do surgery, and after that, you do your best to maintain what you have, and not increase chances of future problems.

Would you share your experience after your follow up at Mayo?

I’ve been thru 2 lumbar fusions last one in April L5 was loose so they fused me from L4 -S1. Don’t be afraid to get other opinions I let this surgeon do mine he was supposed to have done Peyton Mannings worst decision. I would about fall when bending over, now anal , testicular, back, leg pain are worse. I had a disc replaced at L3-L4 in 2001 and now have spinal stenosis, bulging disc in my neck and the surgeon released me at 4-1/2 months after my surgery in April to go back to work as a pipefitter . Still using a cane , can’t go walk thru stores and he’s not looked at my back just says mri says everything is healed try an epidural ( didn’t work) now I’ve talked to 3 surgeons and they all say a pain stimulator. Everyone’s told me to go to Mayo Clinic but I can’t afford it. 51 year old regretting it so please don’t be afraid to make a doctor made because you got other opinions. ( even my pain doctor refused to do stimulator because he thinks somethings wrong)