Re: What Next
I had same thing as you, large annular tear top to bottom of disk on L4/L5, with degenerative (arthritic) disk (shows black on MRI), except a free disk fragment was also impinging a nerve, and I had leg pain and numbness. My doctor also did not want to do surgery because he said most herniations do not require surgery. Have you been told that? Many people think a herniation automatically requires surgery and that isn't true. Most of the time our body heals itself but it takes a long time.
He then said that after five months of not getting better, that I may not get better, especially if I couldn't move around. So there seems to be a window there. He also said that with free disk fragments that have broken loose of the disk completely, 50 % of the time they do not require surgery. He said only 50% of the time do they get reabsorbed by the body. Does that info help?
Now, what caused my problem was that disk fragment wasn't reabsorbing fast enough or at all, and it was impinging the main nerve, the sciatic. A piece of disk was also sitting in the tear itself holding it open.
From what I understand, these tears can take up to 2 years to heal. Understand that if you have surgery, it is only to take the offending fragment out, perhaps the material is sitting in the tear keeping it from closing and healing like mine was, or sitting on the nerve, but they will not fix your tear. That has to heal on its own which is why after surgery you have to be so careful for so long. that's anohter point people don't understand. this is why people often reherniate more material out that disk after surgery. The tear is still there!
As long as you are getting better, even slightly, then they don't want to do surgery. But if you don't make progress over a few months (3, 4?) and cannot exercise, that's bad, because for the tear to heal, you need to exercise to get blood flow to the disk which doesn't have its own blood flow but takes blood from the surrounding tissues. If you start going downhill again, then that's another clear indication of surgery needed. this is what I understand.
He tried the lumbar block on me, which seems the step they take before considering surgery, but 5 days later, I woke up with drop foot. He said the drop foot was a result of the fragment impinging the nerve. At that point, I could not walk, and was getting worse by the minute, so they signed me up for surgery one week later. He was also alarmed when I hadn't seen him for 3 months and then came in in worse pain and said I hadn't exercised or moved much in 3 months. You get worst not moving. You just won't heal if you don't move i guess.
the MRI showed the free fragment on the nerve, but it didn't show how large the annular tear was, nor did it show disk material sitting in tear itself - just to clarify.
Otherwise, i don't know how much longer he would have made me wait til sugery. Even though I was numb in the foot and leg, as long as I could lift that big toe, he wasn't concerned. He wanted to wait and see if I would get better with time on my own. But the minute I could not lift that big toe, it was surgery time. the lumbar block (epidural) was painful and did not work at all for me.
Hope that helps. it took me months to understand the above. I need to why for everything so I can fully understand. ASK LOTS OF QUESTIONS!