Deciding against fusion: what I weighed

In 2022, at 56, two orthopedic surgeons looked at my imaging and recommended a spinal fusion. Two levels of my spine had slipped. The diagnosis was real, the recommendation was sound, and I want to say that clearly before anything else on this page. This is not a story about doctors being wrong. It is a story about one man's decision, for his case, and how it has gone so far.

I am not a doctor or a physical therapist. Nothing here is medical advice. This is what I weighed and what I did. Your case is not my case, and the right answer for you might be the fusion. Talk to your own doctors.

The two years before it had a name

My back first gave out in 2020, when I was 54. Eight weeks bed-ridden, during covid, with no clear diagnosis. After the eight weeks I was walking, with pain. Then came two years of pain that came and went, one specialist after another, and imaging that did not show it yet.

If you are in that stretch right now, I know it. What I had instead of a plan was attention. Which positions I could hold, what lit the pain up, what made the next morning worse. Two years of that. When the diagnosis finally landed, I knew exactly what I was working with, because I had been listening the whole time.

What the surgeons said

Two-level spondylolisthesis. Two separate surgeons, both recommending fusion. Both were straight with me and neither was selling anything. If I heard the same recommendation from two more, I think it would have been the same conversation.

What I weighed

A fusion is permanent. That fact organized my whole decision. Everything else I could try first was reversible, and the fusion would still be there if the everything-else failed. So the question I actually asked was not "surgery or no surgery." It was "what happens if I spend a year exhausting the conservative road first, and what do I lose by trying."

What I stood to lose was a year, and some pain I was already living with. What I stood to gain was keeping my original spine. I talked it over with my doctors, and I chose to try everything else first. Fusion stays on the table today. That is not a loophole in the story. It is the story.

What "everything else" meant

Four things, over years, not months. Physical therapy, which I used as a teacher, not a prescription. Self-directed study of the physiology, so I understood why each exercise existed. Diet. And a small set of supplements. The details of the routine are on the training page, and the whole rebuild is on the story page.

It started from almost nothing. The first exercise was a deadbug, and I could not do one. Progress was one exercise at a time, one rep at a time. It took about a year of PT and my own program before running stopped hurting afterward. I could run the whole time, that was never taken from me. The cost was pain after every run, and it took a year of the right work before that stopped.

How it has gone

I am 60 now, and pain-free. I run a 5k three times a week on trails and do a serious core routine on the other days. This summer I raced the Cougar Mountain Trail Series. In August I ran 28:53, first in my age group, my fastest of the three races.

That is my outcome so far. It is not a promise about yours. Spondylolisthesis has grades, and cases, and mine is one case. I keep saying that because the day this page reads like advice is the day it stops being honest.

Questions people ask me

These come from real people in real comment threads, and I answer versions of them every week.

"They want to fuse. What do I do?"

I cannot answer that for you, and I would not trust anyone on the internet who does. What I can tell you is what shaped my thinking: a fusion is permanent, and for my case, the conservative road was still open and reversible. Two surgeons thought fusion was right for me, and they may have been right. I chose to spend the time first. Ask your surgeon what happens if you try conservative treatment for a defined period. The answer to that question told me a lot.

"Five specialists couldn't figure out what's wrong with me. What did you do about the not-knowing?"

Mine took two years to get a name, so I know that stretch. The only thing that helped was paying attention on purpose. What movement lit it up, what made mornings worse. So that when the imaging finally matched, I already knew my own case cold. I hope your answer comes faster than mine did.

"Did beating it feel like a victory over the doctors?"

Neither, honestly. The diagnosis was right and the fusion recommendation was sound, and fusion is still on the table if I ever need it. There is nothing to beat. There was just work to do.

"I used to be so active, and now I'm told I can't do anything."

Nobody told me to stop moving, so I will not pretend I know that particular blow. What I can say is that for me, the line between what hurt and what helped was not "activity or rest." It was which specific movements, at which intensity, in which order. That is exactly what my PT was for. If you have been told to stop everything, that is a conversation to have with your own doctor, and it is worth asking them precisely which movements they mean.

If you are in the decision right now

I remember what the search results looked like at 2am. Clinics, journals, and not one person who had actually sat where I was sitting. That is why this page exists.

I am not hard to reach. The engage page has my email, and I answer. If you want to see the whole rebuild rather than read about it, the story is on YouTube, one exercise and one race at a time. And if you just want to tell someone where you are in it, tell me. Come back and tell me how the appointment went. I mean that.

Not medical advice. One person's experience. Talk to your own doctors.