Next steps for L4/L5 pain?

Hello,

I am a 30 year old female with history of a small L4/L5 herniation diagnosed in 1998.  I did well after and epidural and pt for many years.  However, last year after moving small boxes, my pain returned,  but instead of presenting only with left hip pain, I now have moderate leg pain to my foot and severe intermittent pain in my back at the disk space.  It is made worse by sitting and almost any kind of movement, especially walking, which is making work and physical therapy quite difficult.  

I am on anti-inflammatories and traction and have tried pt, one recent epidural, a tens unit, rest, etc. yet the back pain seems to be getting worse.  My doctors cannot seem to agree whether I currently have an annular tear, bone spur, herniation, etc. but they all agree my disk has dried up.  I go in for a third MRI next week and will have more epidurals to see if they "take".  

My primary question is:  How long am I supposed to try conservative treatment before I have surgery?  A neurosurgeon I consulted with feels that surgery doesn't often relieve pain in the back, just leg discomfort.  From what I have read, it doesn't seem like back surgeries are very successful, and I feel I need someone to better isolate the problem.   I have had almost one year of difficulty, and I feel like I must find relief, especially for the back pain.  

Thanks for your input!

[kittyluv1]

Conservative treatment usually is tried for up to six months to determine if the cause has been correctly identified and if the treatment will reduce pain.
Degenerative disc disease can result in bone spurs, disc herniation and other conditions being suggested by your doctors,  It gets most confusing when there is no consensus among the medical professionals!
Hopefully your third MRI will provide more definitive information and an ability to determine whether surgical intervention would be helpful.  It is difficult to predict what level of pain might remain postop as each individual outcome varies based on the nature and extent of the procedure performed.
Chronic back pain may leave some residual even with surgical intervention.
Post an update with the new MRI findings and we will try and assist you further.
Best wishes ---

[Carrie30]

Thanks for the reply, kittyluv1.  I received my MRI results today with no major changes noted.  (I wish my drs. would let me know about minor changes; my PT was the only one that noticed a previous report that stated my annular tear seems to be getting bigger).  Here is the latest report:

IMPRESSION:
1. Essentially stable MRI of the lumbar spine compared with
11/08/2008, with a disk bulge at L4-L5 and small annular
fissure. No significant disk changes are identified at L5-S1 as
previously described.
2. The paraspinal muscles and visualized soft tissues are
unremarkable.

Doesn't sound that serious, I know, but no matter the result,  I feel very uncomfortable.  I am curious if I had an annular tear many years ago, or if that is a new issue that has increased the pain in my leg and caused pain in my back.  

I have an appointment for another epidural in two months; if you have any ideas of what I can try in the meantime, or any tests I should ask for, I am open to all suggestions.

Best Regards!  

[alphawolf150]

Consertive treatment lasts as long as it works. There can come a time when it is so longer a viable option. Get another oppinion from a neurologist that is not a part of your treatment team(so they are not jaded by their oppinion of your other docs). Surgery may not be a viable treatment seek out a pain management doc; they are usually a board certified anesthesiologist(the docs that put you to sleep for surgery). You can live a productive happy life even if they can't fix what is wrong. It will test your patients, but it can and will happen. Pain controle usually takes a combination of many different types of therapy and pain docs are very knowledgeable of all of them and are good at finding the right combination. Good Luck!