Sciatica Surgery
Sciatica Surgery
Additional Sciatica Info:
If the sciatica pain is severe and has not gotten better within six to twelve weeks, it is generally reasonable to consider spine surgery. Depending on the cause and the duration of the sciatica pain, one of two surgical procedures will typically be considered: a microdecompression (microdiscectomy) or an open decompression (lumbar laminectomy).
Microdiscectomy (microdecompression) for sciatica
In cases where the sciatica pain is due to a disc herniation, a microdiscectomy may be considered after four to six weeks if the pain is not relieved by non-surgical means. A microdiscectomy may be considered sooner than four to six weeks if the patient’s pain and disability is very severe. Urgent surgery is only necessary if the patient experiences progressive weakness in the legs, or sudden loss of bowel or bladder control.A microdiscectomy is typically an elective procedure, and 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. Approximately 90% to 95% of patients will experience relief from their sciatica pain after this type of surgery.
See also Microdiscectomy
Lumbar laminectomy (open decompression) for sciatica
Lumbar spinal stenosis often causes sciatica pain that waxes and wanes over many years. Surgery may be offered as an option if the patient’s activity tolerance falls to an unacceptable level. Again, surgery is elective and need only be considered for those patients who have not gotten relief from the sciatica after pursuing non-surgical treatments. The patient’s general health may also be a consideration.After a lumbar laminectomy (open decompression), approximately 70% to 80% of patients typically experience relief from their sciatic nerve pain.
See also Laminectomy
To large extent, the patient’s individual situation will dictate his or her decision to have surgery or not.
In 2005 the FDA approved a new surgery designed to relieve symptoms of lumbar spinal stenosis called the X Stop. This procedure involves placing an implant in the very back of the spine that prevents the patient from leaning backwards, a position that typically causes pain in patients with lumbar spinal stenosis.
It is important to note that the decision whether or not to pursue surgical or non-surgical remedies for sciatica is almost always the patient’s decision. There are many considerations for the patient to take into account when deciding whether or not to have surgery.
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Some patients may prefer to try as many different non-surgical 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.
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Some 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 parent 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.
