Unbearable back pain - is surgery recommended

[winf]

May 2000: stopped work .. severe left-side sciatica.

medications/treatments

-Tylenol #3  Robaxisal  Celebrex  Vioxx
-acupuncture
-MRI #1:. degenerative annular bulging at L4-L5/L5-S1, some herniation at L4-L5, narrowing of central spinal canal at L4-L5 level. Desiccation of nucleus pulposus  discs from L2-S1.
-epidural steroid injection
-facet and SI joint cortisone injections + trigger and pyriformis muscle injections
-Methadone  Neurontin  Fentanyl patches
- MRI#2 . L3-L4 a left posterolateral disc herniation indenting dural sac and impinging on left priximal L4 nerve roots; central disc herniation L4-L5 producing stenosis of bilateral L5 nerve roots

Dec 2010, pain intensified, can’t sit, stand, lie down.
-Jan 25/11- MRI#3  
T12-L1 OK
L1-L2 Mild bilateral degenerative facet disease, greater on right. Minor broad-based posterior disk bulge with left paracentral 2 mm disk protrusion. Adequate central canal and bilateral neural foramina.
L2-L3 Left paracentral disk extrusion 7 x 4 x 2.5 mm (CC x AP x TR). Bilateral degenerative facet disease ; associated ligamentum flavum hypertrophy. central canal and neural foramina OK. Protruded disk appears to contact traversing left L3 nerve root within central canal.
L3-L4 Bilateral degenerative facet disease. Moderate ligamentum flavum hypertrophy. Minor broad based posterior disk bulge with 1 mm left paracentral disk protrusion. Adequate central canal, bilateral neural foramina.
L4-L5 Bilateral degenerative facet disease and ligamentum flavum hypertrophy. Minor broad based posterior disk bulge. Adequate central canal, bilateral neural foramina.
L5-S1: Bilateral degenerative facet disease and ligamentum flavum hypertrophy. Minor broad based right posterolateral disk osteophyte complex. Central canal, neural foramina OK.

Questions:
1. Root cause of  pain?
2. Recommended treatments/procedures?
3. Physiotheraphy recommended?
4. Surgery recommended? (type, success rate, risks?)

Thank you.

[brokebackdave]

i cant say i totaly agree with last reply. you have a long list of issues and not all of them are serious. the L2-L3 disc seems be the worst one as a 7mm bulge can cause fair amount of pain. it's kinda borderline. i would seriously consider getting that segment fused. i didnt see what age you are, but if you are 35+ years old i would say fusion. if you are yonger you may talk to your doctor about a discectomy. this is where they will go in and just cut out the bulge and remove it. that may relieve the nerve pain down left leg. if your older than 35 and you have a 7mm bulge they can do the discectomy, but it may just start bulging again a little later down the road. not only that, after it bulges the second time you are loosing disc hight again. sooner or later you will be bone on bone, which is unstable and painfull. your other option might be to do a nerve block on the effected nerve roots. i dont agree with the #4 response if they are talking about fusion. with a discectomy i would however agree. i'm not a doctor but had 10mm bulge L5-S1, L4-L5 3mm bulge with anular tear, Degenerative disc disease. curious what your doctor would say. most of what you have had done is considered conservative treatment. its clearly not working either. time for more drastic mesures. i to have had numerous spinal injections of all kinds, they never did anything for me. best of luck to you! (by the way, you didnt mention if this was a work comp injury.) that would explain all the injections and no surgery) as was my case.

[percocet10mg325mg10]

Answers:
1. buldging disk(s) are protruding into nerve canal.
2. Get on Pain Management
3. not sure what that is
4. No.  Surgery will only work for 3 to 4 years and problems will resurface in same spots or others. And that is not worth all the pain and discomfort caused by surgery in my experience. Trust me, once they start going bad...backs continue to go bad.