Surgery for sciatica is usually considered when leg pain and/or weakness is persistent or progressive even after several methods of non-surgical sciatica treatments have been tried. In a few cases, surgery may be considered as the first option.
A few examples where surgery is considered as a first option are:
- Cauda equina syndrome—a medical emergency where nerve roots of the cauda equina are compressed and motor and sensory function in the lower body are lost.
- Tumors, collection of fluid (cyst or abscess), or severe fractures in the lumbar spine
- Bilateral sciatica—sciatica affecting both legs, may be caused by multiple level disc herniation, severe single level herniation, or central spinal stenosis.
Watch: Lumbar Herniated Disc Video
- Infection in the pelvic region that does not respond to medication.
In addition, surgery may be considered when leg pain and/or weakness persists for more than 6 to 8 weeks despite nonsurgical treatments and/or when pain affects everyday activities.
See Leg Pain and Numbness: What Might These Symptoms Mean?
Surgery is performed with the goal of eliminating the cause of sciatica and to control the leg symptoms such as pain and weakness. Back pain associated with sciatica, however, may not improve after surgery. 1 Kumar, M. Epidemiology, pathophysiology and symptomatic treatment of sciatica: A review. nt. J. Pharm. Bio. Arch. 2011, 2.
Watch: Video: What Is Your Sciatic Nerve and Why Does It Hurt So Much?
Microdiscectomy for Sciatica
Microdiscectomy is a common surgical approach used to treat sciatica that is caused by a lumbar disc herniation. In this surgery, a small part of the disc material under the nerve root and/or bone over the nerve root is taken out. While technically an open surgery, a microdiscectomy uses minimally invasive techniques and can be done with a relatively small incision and minimal tissue damage.
See Microdiscectomy (Microdecompression) Spine Surgery
Research shows up to 86% of patients may experience sciatica pain relief after a microdiscectomy surgery. 2 Gulati S, Madsbu MA, Solberg TK, et al. Lumbar microdiscectomy for sciatica in adolescents: a multicentre observational registry-based study. Acta Neurochir (Wien). 2017;159(3):509–516. doi:10.1007/s00701-017-3077-4.
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Lumbar Decompression Surgeries
A number of surgical approaches are available to relieve various sources of nerve root compression or irritation, such as:
- Laminectomy. In this procedure, part or all of the lamina is removed in order to provide more room for the spinal nerves. It is most commonly done for sciatica pain caused by lumbar spinal stenosis. An estimated 75% to 90% of patients may experience pain relief after lumbar laminectomy surgery. 3 Dakwar E, Deukmedjian A, Ritter Y, Dain Allred C, Rechtine GR II. Spinal Pathology, Conditions, and Deformities. In: Pathology and Intervention in Musculoskeletal Rehabilitation. Elsevier; 2016:584-611. doi:10.1016/b978-0-323-31072-7.00016-6. , 4 Agabegi SS, McClung HL. Open lumbar laminectomy: Indications, surgical techniques, and outcomes. Seminars in Spine Surgery. 2013;25(4):246-250. doi:10.1053/j.semss.2013.05.004.
- Foraminotomy. In this procedure, the neuroforamen is enlarged by removing bony overgrowth, providing more room for the nerve root as it exits the spinal column through this opening.
- Facetectomy. This surgical procedure used to relieve compression on pinched nerves caused by degenerated facet joints. The facet joints are typically trimmed, undercut, or removed to relieve nerve pressure. It is estimated that 85% of patients may experience pain relief after a facetectomy surgery. 5 Cawley DT, Shenoy R, Benton A, et al. The evolution of partial undercutting facetectomy in the treatment of lumbar spinal stenosis. J Spine Surg. 2018;4(2):451–455. doi:10.21037/jss.2018.06.06.
As appropriate, these procedures may be combined and performed at the same time. For example, a laminectomy procedure may be done along with a foraminotomy, and the surgery is called a laminoforaminotomy. Additional procedures may be done in combination with the above, include osteophyte (abnormal bone growth) and/or hypertrophic (overgrown) ligament removal.
As with any surgery, a number of risks are possible, including but not limited to a risk of nerve or spinal cord damage, bleeding, infection, clot formation, and continued symptoms post-surgery.
See Microdiscectomy Spine Surgery: Risks, Complications, and Success Rates
Research suggests that surgery for sciatica may provide better reduction in pain and improvement in functional outcome for up to 1 year as compared to nonsurgical treatments. However, in the long term (4 to 10 years), the outcome for both approaches are usually similar. 1 Kumar, M. Epidemiology, pathophysiology and symptomatic treatment of sciatica: A review. nt. J. Pharm. Bio. Arch. 2011, 2.
The decision to have surgery for sciatica pain is typically a patient’s choice unless there is a medical emergency, such as cauda equina syndrome. The patient’s decision to have surgery is based primarily on the amount of pain and dysfunction, the length of time that the pain persists, the patient’s overall health, as well as the patient’s personal preference.