u/drhof

I’m in my mid-30s and have had chronic low back pain for several years. I’m otherwise healthy and fairly active, but the back pain has gradually become more limiting despite a lot of conservative treatment.

Over the years I’ve tried physiotherapy, chiropractic treatment, naprapathy/manual therapy, exercise/rehab, anti-inflammatory medication, muscle relaxants and other pain medication.

I’ve stayed active with things like walking, cycling and swimming, but the pain never really goes away.
My symptoms are mainly axial low back pain rather than classic sciatica. At its worst it can be around 7–8/10. Neurological examination has been normal.

My MRI shows mild degenerative changes in the lower lumbar spine, most pronounced at L5-S1. There are mild disc bulges, but no significant spinal stenosis, foraminal stenosis or nerve root compression. The latest MRI also showed new mild degenerative bone marrow edema at the lumbosacral level.

My spine doctor suspects L5-S1 is the pain-generating segment. Because I’ve had symptoms for such a long time and have already done a lot of conservative treatment, I’ve now been referred to a spine surgeon to discuss a possible single-level L5-S1 fusion.

The difficult part is that my doctor was very clear that this is not an obvious surgical case. There isn’t a major herniation, instability or nerve compression that clearly needs fixing. Surgery is basically an option because of the duration of the pain, failure of conservative treatment and the suspicion that L5-S1 is the pain generator.

So I’m struggling with the decision.

For those of you who were in a similar situation, mainly chronic discogenic/axial pain, without major nerve compression:
* What ultimately made you choose fusion or decide against it?
* How much did your pain and function improve after a single-level L5-S1 fusion?
* Did you develop adjacent segment problems at L4-L5 later?
* How long did it realistically take before you could work again, especially with a desk job?
* If you could make the decision again, would you do the same?
* Is there anything you wish you had asked your surgeon before deciding?

I’m not looking for Reddit to make the decision for me. I’m mainly interested in hearing how others in a similar grey-zone situation thought through the trade-off between living with chronic pain versus accepting the risks and uncertainty of fusion.