Re: With two Laminectomies under my belt...
You ask a question that is really difficult to answer. What is "right" for one, is probably not the answer for someone else. I don't know if we have statistics that indicate the likelihood of being able to continue to run marathons after either ADR or fusion. Is that your goal?
All of life is a balancing act. I know some surgeons will tell a patient that he can do anything he pleases after a fusion...my first surgeon was of that opinion. However, I tend to be more conservative in my thinking. If I were your age, I would be thinking that I would like to have a good quality of life in my senior years...and that if I could find physical activity and exercise that I enjoyed, that was a bit kinder to my back, I would be willing to make the trade.
We know certain activities put more wear and tear on the discs than others. It is a matter of weighing options and making decisions.
Now, in your case, you have had back problems at a fairly young age, so perhaps your body is a bit more susceptible to future spine problems than other people your age.
As to when you should have surgery, and what type...again, a difficult call. I can tell you from personal experience having 3 lumbar surgeries and having participated in boards like this one for years and having read MANY surgical stories, when the surgery has a good outcome, patients wish they had NOT waited so long...but when the outcome results in an unexpected issue such as drop foot, or the patient is left with even more pain, then they wish they had postponed, or never done it.
When you have nerve compression such as it sounds like you do, you never know at what point permanent nerve damage may result. But, if your toes are numb for years prior to surgery, you can pretty well count on them staying numb. But, will it happen after 3 months? 6 months? Longer??
Unfortunately, no one can tell you for sure....they can only give you statistical information.
If you are torn between fusion and ADR, I would suggest you research ADR now to see if you would even be a candidate. I never paid much attention and didn't bother learning all about ADR because I knew I could not have the procedure due to my spondylolisthesis. You should look to see what conditions would preclude you from having ADR before getting your heart set on that particular procedure!
I postponed having a lumbar fusion for several years, thinking that, surely, technology would catch up and a better way to resolve my problems would arrive in time to help me. When it got to the point that I was driving to my mailbox to get the mail and I had a stool in the kitchen so I could sit every couple minutes in order to be able to chop one onion, I knew it was time, and that I had to do something.
I would just encourage you to find the very best surgeon that is available to you, to take time and really research whomever you select. Other than the decision to have surgery in the first place, the selection of the surgeon is the most important decision you will make. And it is always a good idea to get a number of opinions, just to be sure you aren't overlooking a different solution to your issues.
Do you ever wonder where you might be today if you hadn't had that first laminectomy?