Sciatica is characterized by pain that radiates along the path of the sciatic nerve, which branches from the lower back through the hips and buttocks and down each leg. It is typically caused by compression or irritation of the sciatic nerve roots in the lower spine. While many cases of sciatica can be treated conservatively with rest, medication, physical therapy and other non-surgical approaches, surgery may be an option for some patients who do not experience relief from non-operative care.
What are the surgical options for sciatica?
There are several different surgical procedures that may be considered for patients with refractory sciatica:
- Microdiscectomy – This procedure removes a portion of a herniated disc that is compressing the sciatic nerve root. It is one of the most common surgeries for sciatica.
- Laminectomy – This surgery removes a portion of the bony arch (lamina) of a vertebra to decompress the nerve roots. It may be done along with a discectomy.
- Foraminotomy – This procedure widens the neural foramen, which is the opening where the nerve root exits the spine. This relieves pressure on the nerve root.
- Spinal fusion – An intervertebral fusion stabilizes the vertebrae and limits motion that may be irritating the sciatic nerve. It may be done along with a laminectomy or foraminotomy.
The specific surgical procedure recommended will depend on the underlying cause and location of nerve root compression or irritation causing a patient’s sciatica symptoms.
When is surgery considered for sciatica treatment?
Surgery for sciatica is generally only considered when conservative treatments like medications, physical therapy, spinal injections and other non-surgical therapies have failed to provide adequate pain relief and functional improvement. Specifically, surgical treatment may be recommended in cases of sciatica when:
- Symptoms persist for 4-6 weeks despite nonsurgical treatment
- There is progressive nerve damage or weakness in the leg
- Severe or worsening pain is disrupting normal activities and quality of life
- Diagnostic tests show compression or irritation of a nerve root correlating with symptoms
The decision about whether or not to have surgery is complex and needs to be discussed carefully with your doctor. Potential risks and benefits of the different surgical options should be considered before proceeding.
What are the potential risks and complications of sciatica surgery?
All surgeries carry some risks, which need to be weighed against potential benefits. Possible risks and complications associated with surgery for sciatica include:
- Infection
- Bleeding
- Blood clots
- Nerve injury
- Worsening pain or numbness
- Spinal fluid leak
- Need for revision surgery
- Adjacent segment disease requiring additional surgery
Proper surgical technique and meticulous postoperative care can reduce some of these risks. Stopping smoking and optimizing other health conditions prior to surgery also improves outcomes.
What is the recovery and rehab like after sciatica surgery?
Recovery time after surgery for sciatica depends on the type of procedure performed. Less invasive options like a microdiscectomy or foraminotomy may require only 2-4 weeks of recovery. More extensive procedures like spinal fusion often need 3-6 months for complete recovery.
Typical post-op guidelines include:
- Avoiding bending, lifting and twisting for 1-3 months
- Walking short distances early and gradually increasing activity
- Wearing a back brace for stabilization
- Home exercise program to improve flexibility and core strength
- Physical therapy 2-4 weeks after surgery focusing on core stability, posture and conditioning
Full relief of leg pain often occurs immediately after surgery. Low back pain may persist for a few weeks but should gradually improve with rehab. Use of pain medications can help control post-surgical discomfort.
How effective is surgery for treating sciatica?
Multiple studies show surgery can provide significant relief of sciatica symptoms in properly chosen patients who have not responded to conservative care. One literature review found:
- 60-90% of patients achieve complete leg pain relief after lumbar microdiscectomy
- 71-92% rate the results of laminectomy as good to excellent
- 71-90% experience significant pain reduction with a foraminotomy
- Approximately 90% improve after spinal fusion for appropriate indications
Patient selection, surgical technique and meticulous post-op care help optimize outcomes from sciatica surgery. Although good results are expected, some patients may only experience partial pain relief or require additional treatment.
What are the alternatives to surgery for sciatica treatment?
For patients who are not candidates for surgery, wish to avoid surgery, or have incomplete pain relief from an operation, some other options for managing sciatica include:
- Medications – Oral NSAIDs, muscle relaxants, neuropathic pain medications may provide symptom relief.
- Epidural steroid injections – Cortisone injected near inflamed nerve roots reduces inflammation.
- Physical therapy – Stretching, strengthening exercises, modalities like heat/ice/TENS unit can help symptoms.
- Chiropractic – Spinal manipulation and mobilization may relieve nerve root irritation.
- Acupuncture – Fine needles placed in specific points may interrupt pain signals.
- Yoga/Pilates – Gentle stretching and core strengthening helps reduce flare-ups.
- Massage – Soft tissue techniques relax tight muscles that contribute to pain.
Lifestyle measures like weight loss, smoking cessation, ergonomic adjustments at work, stress management and adequate rest are also important in controlling symptoms.
Conclusion
Surgery can provide significant relief for patients with sciatica that is refractory to conservative treatment. Procedures like microdiscectomy, laminectomy, foraminotomy and spinal fusion decompress irritated nerve roots and stabilize the spine. Though invasive, surgery may improve function and quality of life when nonsurgical options have failed. A thorough discussion with the surgical team helps determine if the potential benefits outweigh the risks for an individual patient. With appropriate patient selection and surgical technique, the majority of patients can expect substantial reductions in leg pain and disability after surgery for sciatica.