Typically, it is reasonable to consider surgery for sciatica in the following situations:
- Severe leg pain that has persisted for four to six weeks or more
- Pain that is not relieved after a concerted effort at non-surgical sciatica treatments, such as oral steroids, non-steroidal anti-inflammatory medication, manual manipulation, injections, and/or physical therapy
- Limitations on 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.
Depending on the cause and duration of the sciatica pain, one of two general surgeries will typically be considered:
Microdiscectomy for Sciatica
In cases where the sciatica pain is due to a lumbar disc herniation, a microdiscectomy—a small open surgery using magnification—is the most common surgical approach. 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.
A microdiscectomy is generally considered after four to six weeks if severe pain is not relieved by nonsurgical means. If the patient’s pain and disability are severe, surgery may be considered sooner than four to six weeks.
As a general rule, approximately 90% of patients will experience relief from their sciatica pain after this type of surgery.8
Lumbar Laminectomy for Sciatica
In cases where 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 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.
One extensive analysis following thousands of patients found laminectomy alone or combined with a discectomy had a success rate of 78%.9
Minimally invasive, or outpatient, versions of both of these surgeries are also now available as an option.
Surgery Is the Patient’s Decision
In most cases, sciatica surgery is elective, meaning that it is the patient’s decision whether to have surgery or not. 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 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 to take into account when deciding whether or not to have surgery.
Effectiveness of nonsurgical treatments
Some patients may prefer to try many different nonsurgical sciatica treatments and remain with nonsurgical care for as long as possible. 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 relief
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 patient with small children may not have the time to pursue nonsurgical remedies and may need immediate pain relief in order to be able to take care of the children and household duties.
Medical studies on the benefits of surgery rather than nonsurgical treatment are mixed. Some research indicates that surgery to treat sciatica brings faster pain relief than nonsurgical measures, but that the outcome of both approaches is similar after about a year.10
One study that followed patients for an 8-year period, however, found more improvement in pain and functioning among those who chose surgery.11
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.
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