Sciatica is a debilitating condition characterized by pain that radiates along the path of the sciatic nerve, which runs from the lower back down through the buttocks and into the legs. For many patients, the pain is severe and impairs their ability to work, exercise, and enjoy daily activities. When conservative treatments like rest, medication, and physical therapy fail to provide relief, some patients opt for surgery. But is undergoing an invasive procedure like back surgery really worth it for sciatica?
What causes sciatica?
Sciatica is caused when something presses on or irritates the sciatic nerve roots. The most common cause is a herniated or slipped disc in the lower spine. A herniated disc occurs when one of the rubbery cushions between the vertebrae ruptures and leaks disc material. If this material presses on the nerve roots as they exit the spinal column through the neural foramina (passageways between the vertebrae), it can cause inflammation and sciatic pain.
Other causes of sciatica include:
- Spinal stenosis – Narrowing of the spinal canal that compresses the nerves
- Spondylolisthesis – Vertebral slippage that pinches nerves
- Piriformis syndrome – Tightness or spasm in the piriformis muscle that irritates the sciatic nerve
- Pregnancy – Pressure from the uterus on the sciatic nerve
- Trauma – Direct nerve injury from trauma
- Tumors – Benign or malignant growths affecting the nerve
No matter the cause, the sciatic pain originates from nerve root impingement in the lower spine. That’s why surgery to relieve pressure on the nerves is often recommended for persistent, debilitating cases.
What does sciatica surgery involve?
There are two main surgical procedures to treat sciatica:
Microdiscectomy
A microdiscectomy is performed when a herniated disc is pinching a nerve root. The surgeon removes a portion of the protruding disc material to decompress the nerve. They make a small incision and use a microscope to view the disc space. This minimally invasive surgery has a shorter recovery time than traditional discectomy procedures.
Laminectomy
A laminectomy is done when there is spinal stenosis compressing the nerves. The surgeon removes a portion of the lamina bone and sometimes other posterior vertebral structures to create more space in the spinal canal. This takes pressure off the spinal nerves and reduces sciatic pain.
Laminectomy can be done alone or in combination with other procedures like discectomy or foraminotomy. Foraminotomy widens the neural foramina passages to further decompress pinched nerves.
What is the success rate for sciatica surgery?
Studies show that back surgery can effectively relieve sciatica in 75-90% of appropriately selected patients. However, there are some important points about surgical success rates:
- Success is lower for workers compensation patients versus general population.
- Smokers have less pain reduction from surgery than nonsmokers.
- The longer the duration of preoperative symptoms, the lower the success rate.
- Patient selection is key – those with clear disc herniations pressing on nerves do better than patients with vague symptoms.
- Surgery for spinal stenosis has lower success rates than for disc herniations.
Here is a table summarizing the success rates from various studies:
| Study | Procedure | Success Rate |
|---|---|---|
| Atlas et al | Discectomy | 75% |
| Sabnis et al | Discectomy | 90% |
| Javid et al | Laminectomy | 63-71% |
| Kim et al | Laminectomy | 71% |
As you can see, discectomy procedures tend to have higher success rates than laminectomies. But even laminectomy can provide good relief of leg pain in most patients with lumbar stenosis.
Does sciatica ever recur after surgery?
Yes, there is a chance of recurrence after surgery for sciatica. Recurrence rates range from 3-18% after discectomy and around 10% after laminectomy. Smokers and workers compensation patients again have higher rates of recurrence.
Sciatica can recur if:
- Scar tissue compresses the nerves
- Another disc herniates
- Spinal instability develops
- Foraminal stenosis progresses
- Residual or recurrent disc fragment is missed
Many surgeons will combine discectomy with microendoscopic decompression to clear all disc material and minimize recurrence. Physical therapy after surgery also helps prevent recurrence.
Are there alternative treatments?
Surgery should not be rushed into. Most experts recommend trying conservative treatments for at least 6 weeks before considering surgery. Options to try first include:
- Medications – Oral steroids, NSAIDs, muscle relaxants or neuropathic pain medications may provide relief.
- Epidural steroid injections – Steroid injections around irritated nerve roots can reduce inflammation.
- Physical therapy – Stretching, strengthening exercises and modalities like heat/ice therapy can help manage symptoms.
- Spinal decompression – Non-surgical traction devices can take pressure off compressed nerves.
- Alternative medicine – Options like acupuncture, massage and yoga may provide relief for some patients.
- Time – Many cases of acute sciatica resolve with rest and conservative care within weeks.
Surgery should be considered if conservative treatments fail and pain is disabling. But non-operative management is ideal for milder cases that just need time to improve.
Conclusion:
Surgery can provide effective relief of leg pain and disability for patients with persistent sciatica. Discectomy and laminectomy procedures have relatively high success rates of 75% or more. However, benefits have to be weighed carefully against surgical risks and recurrence potential for each individual patient. Trying conservative treatments first for at least 6 weeks is warranted in milder cases. But for severe, debilitating sciatica that has not improved with adequate non-operative management, surgery may offer significant pain reduction and improved quality of life.