[RayRay]

I am new to the forum and would like some advice on treatment options, ect.

I have been living with a herniated L4-L5 disc for approx 20 years. I also have a dark and degenerated L5-S1 that does not seem to cause me problems and several other slight herniations on other lumbar discs. Only L4-L5 and S1 show dark disc material, others are fairly healthy. I am 46 years old, active ( skiing and biking) when not in bad shape as I am now.

Over the 20 years I had a good neuro surgeon in the US that was a strong proponent of conservative therapy " If you have control of your bowel and bladder, we will not cut!"

I had some tough episodes that sometimes included siatica and some brutal back spasms, the worst was in 2000. That took me approx 6 months to get better and involved me laying on my belly at work with my laptop. Getting in and out of my car was brutal, but I marched on. The episodes in between were minor tweaks every 3-4 years with spasm and hunched over walking for a few weeks the typical result.

Exercise seemed to be the key for me. If my core was right, my pain was absent.

Last fall I began a new chapter. I now live in Germany just outside Frankfurt. I saw my General Practicioner GP and he gave me some relaxers and when I improved I went to Physio. I did very well and skied in Zermatt in February..I skied hard and had no problems.
In late march I began to run again, ( though my old US doc strongly advised against any high impact stuff like running) I started to feel sharp pain in my hip and attributed it to periformous muscle. I had no spasm at first. soon I began to wake up with a crooked, spasm back. I went back to my GP and we started with Muscle relaxers again with the idea of going back to Physio. Soon after I got out of the shower one morning before work, sneezed and hit the deck with intense pain. The disc seemed to blow out the back left. GP got me and MRI and I had a nasty 9mm herniation that was now causing siatica and mucho pain. 5 weeks of 2 hours of sleep in a position that made me look like spiderman climbing a wall.

I visited a surgeon in Munich Dr. Hellinger because I understood he does minimally invasive procedures which I believed would be better than open microdiscectomy. My consult was fine. He reccomended I get the disc herniation removed and said he could do it with a lateral indoscopic procedure (ala Yueng). Procedure would be an Inside out using his Discfx tools. Sounded decent, but I told him I wanted to continue to try conservative. He said, fine, keep my number handy and good luck!

I started to progress ever so slightly but Recently it has felt worse and my GP sent me to have another MRI. Latest one shows more degeneration and more pushing of disc material into the nerve canal. A visit with the nuero surgeon at the BUG Klinik in Frankfurt resulted in him saying we need to do a microdiscectomy now. I said no since I have pain and limited mobility, but no nerve damage or muscle weakness. He said try an epidural cortesone injection which I did on Monday morning. No improvement yet, but has not been 3 days yet so I will see.

OK sorry for all the background, but here are my questions:
1. Am I crazy to think I can avoid the knife? Is an operation enevitable?
2. Is there a spine Klinik here in Germany I should be visiting? One committed to "Less is More" and minimally invasive procedures?
3. Would an operation to remove the herniation allow me to get back to my former active self or am I on the slide to hell?
4. What else can you advise..Thanks Ray Ray