Typically, it is reasonable to consider surgery for sciatica in the following situations:
- Severe leg pain that has persisted for 4 to 6 weeks or more
- Pain relief that is not achieved after a concerted effort at non-surgical sciatica treatments, such as one or a combination of oral steroids, non-steroidal anti-inflammatory medication, manual manipulation, injections, and/or physical therapy
- The condition is limiting the patient’s ability to participate in everyday activities
Urgent surgery is typically only necessary if the patient experiences progressive weakness in the legs, or sudden loss of bowel or bladder control, which may be caused by cauda equina syndrome.
Microdiscectomy for sciatica
In cases where the sciatica pain is due to a lumbar disc herniation, a microdiscectomy or small open surgery with magnification may be considered. In this surgery, only the portion of the herniated disc that is pinching the nerve is removed - the rest of the disc is left intact.
This surgery is generally considered after 4 to 6 weeks if the severe pain is not relieved by non-surgical means. If the patient’s pain and disability is severe, surgery may be considered sooner than 4 to 6 weeks.
As a general rule, approximately 90% to 95% of patients will experience relief from their sciatica pain after this type of surgery.
Lumbar laminectomy for sciatica
In cases where the sciatica pain is due to lumbar spinal stenosis, a lumbar laminectomy may be recommended. In this surgery, the small portion of the bone and/or disc material that is pinching the nerve root is removed.
Laminectomy surgery may be offered as an option if the spinal stenosis causes the patient’s activity tolerance to fall to an unacceptable level. The patient’s general health may also be a consideration in whether or not to have surgery.
After a lumbar laminectomy (also called an open decompression), approximately 70% to 80% of patients typically experience relief from their sciatic nerve pain.
Surgery is the patient’s decision
In most cases, sciatica surgery is elective, meaning that it is the patient’s decision whether or not to have surgery. This is true for both microdiscectomy and laminectomy surgery.
The patient’s decision to have surgery is based primarily on the amount of pain and dysfunction the patient is experiencing, and the length of time that the pain persists. The patient’s overall health is a consideration as well.
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Additional sciatica surgery considerations
There are many personal considerations for the patient to take into account when deciding whether or not to have surgery.
Effectiveness of non-surgical treatmentsSome patients may prefer to try as many different non-surgical sciatica treatments and remain with non-surgical care for as long as possible, and often they will figure out how to successfully manage their condition and keep painful symptoms at bay.
For example, a patient who has intermittent flare-ups of severe sciatica pain may find that a combination of initial rest and an epidural steroid injection followed by a gentle stretching and exercise program is effective in alleviating the pain as needed.
Need for immediate pain reliefSome patients may have a personal preference or a life situation that will benefit from the more immediate pain relief that is usually afforded by surgery. For example, a patient with small children may not have the time to pursue non-surgical remedies and may need immediate pain relief in order to be able to take care of the children and household duties.
The important point is that it is almost always the patient’s decision whether or not to have the surgery, and the surgeon’s role should be to help inform that patient of his or her options to help the patient make the best choice.