Shoreline

Hi Scott, It sounds like you already have this figured out. It makes no sense to have a fusion if your pain level is manageable and you don't have any neuropothy. Meaning you haven't lost reflexes, you don't have foot drop, and you haven't mentioned any leg pain. So there is no nerve to decompress to call a surgery a success.
Fusing to S1 has it's own set of ramifications. It changes the axis from your hips which were designed to bear your entire upper body weight to the disc above your fusion. So the disc at L4-5 will bear the brunt of all your weight which will eventually cause that disc to go. It can also play havoc on your SI joints.

It changes the way you sit, the way you walk and creates problems with balance.
Plus there is no guarantee you won't end up with more pain than you have now. You are already at a lower level of pain than most PM docs will even shoot for. I haven't seen anything lower than a 6 in the past 10 years. I've had 3 surgeries, 2 fusion's and the decompressions were all a success but not a single fusion grew and stabilized my spine. I broke the first set of hardware from the fusion of L3-4-5, the stress it put on the discs above and below ruptured 3 more discs. I went in to have my hardware replaced and woke 11 hours later fused from L1-S1.

I haven't been able to work since the last surgery and broke one of the new screws last summer. So that fusion has obviously failed or there wouldn't be stress on the hardware. Hardware is designed to hold things in place while the bone fuses and eventually becomes stronger than the hardware.

There is no concessus on the right way to do fusion. Posterior approach, posterior and anterior "global fusion," rods and screws, or BAK cages. Bone growth stimulators or not. Donor cadaver bone or harvested bone, Artificial disc replacement, I met one guy from FLA where they used coral. Although fusion's have been done for 30 years there is no concessus on the right way to do a fusion. Docs do it the way they learned and keep doing it the same way. Some like to try every new piece of hardware that hits the market although I doubt any of the hardware is FDA approved for the spine.

Both sets I have had implanted didn't have FDA approval for the spine. Pedicle screws are approved for use in the Femur, not the spine, so you sign a release to use hardware for off label purposes, making you a guinea pig. Or you become one of the people taking part in the clinical trials of whatever type of hardware the doc likes.

I take 150 mgs of meth a day plus another 90 to 120 mgs of instant release morphine. IF your not aware of the potency of meth my dose would equate to about 600mgs of long acting morphine per day plus the instant release. I was bedridden for 10 months and wasn't able to move the hospital bed out of my den until I reached a level of pain meds that most non CP patients would consider absurd.But the meds allow me to care for my daughter and home and do all the cooking, cleaning and shopping, I just have to rest every 10 minutes

My own Neuro surgeon calls my surgery a success, because the last flexion and extension X-rays he took things seemed in tact. They basically look for movement of hardware. So even though I couldn't walk, couldn't stand without support in the shower my doc called the last surgery a success. He doesn't even know his hardware has broken because of our disagreement about my condition. I say I'm in pain, and based on an Xray that doesn't tell you if the Donor bone is alive or growing or just dead and sitting there until it's reabsorbed he calls it a success.

I crunch and squeak with every step and can only stand for 15 minutes, sitting is a little better, I can sit for almost a half hour before sweat starts dripping from my nose. I have no feeling from my waist to my knees and have no other choice now, Besides medication for pain. Nobody would even try to redo a fusion for the 3rd time that stretches from L1-S1 unless a rod popped through my skin.

SO IMO, If your pain level is in the 3-4 range with a a couple percs a day and you can still work, you have no business in an OR or even considering a fusion.
Sure, some people benefit from fusion's and their fusion's grow and stabilize their spine. I'm what happens when it doesn't. Is it worth risking all this to please someone else about the number of pills you take?

I've never even met a surgeon that would operate without a neuropathic component to the problem that they can absolutely fix, they can relieve nerve compression but spine surgery to reduce back pain is crazy and anyone willing to operate promising relief of back pain is lying and looking to buy a new boat. My last surgeons bill was 34k and he wanted his hourly surgical rate to give a deposition to my attorney for Social security disability at the age of 34. It only took 2 years to win my case, we lost our home,I had a heart attack, lost a car, my marriage is wreck. How many years can you pay your mortgage without an income?

No doc is going to paint this picture, and you will have problems with friends and family about the meds. What came to your mind when I said I Take methadone?
The only thing lay people know about meth is that it's for heroin addicts and the only thing the know about morphine is that it's for cancer patients.

When it comes to pain management, there are aggressive docs out there but a 50% reduction in pain is considered a success. A 50% reduction puts me at about a 6, and I have experienced pain that others can't even imagine. No amount of morphine or Methadone or Fentanyl will give me back my life.

When you go under the knife you roll the dice and hope for the best. If it's your wife worried about 4 percs a day have her read this post and ask her if it's worth this kind of risk to try to live without meds.That choice was never offered to me until I was already a surgical mess that nobody would touch.
Welcome and good luck, Shore