Surgery for Sciatica

4 situations when sciatica surgery may be necessary.

Peer Reviewed

If weeks of medication or physical therapy hasn’t worked to ease your sciatica, don’t panic. Patients who fail to respond to conservative treatment often find relief through surgery. But what procedure makes the most sense for you? What will the experience be like? And how long will it be until you can get back to a normal, pain-free life?

Surgeon adjusting surgical lamp.There are several types of surgical procedures used in spine surgery, and your spine surgeon will recommend the best procedure to treat your sciatica. Photo Source:

The Essentials of Sciatica

Sciatica is pain that radiates along the biggest, longest nerve in your body, called the sciatic nerve. Pain typically begins in your lower back and extends down one leg, though it can involve both legs. This pain can be mild or severe, and it can worsen when you sneeze, cough, bend or even sit a certain way. Frequently, it’s accompanied by numbness, tingling or weakness in affected legs.

Sciatica is not an illness in and of itself. Rather, it is caused by a separate medical problem, such as spinal stenosis, an injury, a tumor—or, about 90% of the time, a herniated disc in your lower back. Discs are the structures that separate your vertebrae. When the soft center of a disc pushes through its tough exterior, it can pinch or press on sciatic nerve roots, causing pain.

Some research suggests sciatica affects 1% to 5% of the general population each year , and up to 40% of us will experience it at some point in our lifetime. Men between the ages of 30 and 50 have a higher risk of developing symptoms, as do smokers, people who sit for long periods, and those whose jobs are physically strenuous. Obesity and diabetes are also risk factors.

Doctors can diagnose most cases of sciatica by taking a medical history and performing a physical exam. Diagnostic imaging may be used in some cases, as well.

When Surgery Should Be Considered for Sciatica

Most patients with sciatica respond well to nonsurgical treatments (eg, medication, epidural spinal injection), so spine surgery is seldom needed to treat low back and leg pain caused by sciatic nerve compression. However, there are situations when you may want to go ahead with spine surgery:

  • You have bowel or bladder dysfunction—rare, but it may occur with spinal cord compression and cauda equina syndrome
  • You have spinal stenosis, and your doctor feels that surgery is the best way to treat it
  • You are experiencing other neurologic dysfunctions, such as severe leg weakness
  • Your symptoms become severe and/or non-surgical treatment is no longer effective

There are several types of surgical procedures used in spine surgery, and your spine surgeon will recommend the best procedure to treat the cause of your sciatica. His or her recommendation will be based on the spinal disrder causing your sciatica, and the entire procedure should be clearly explained to you. Don't be afraid to ask any questions you need to in order to better understand the surgeon's recommendation.

And remember, the final decision to have surgery is always up to you. You may find it useful to get a second opinion on the recommended spine surgery before deciding. Sciatica often goes away by itself, and the majority of remaining cases can be managed with conservative treatment. Depending on the underlying cause, this can involve heat or cold packs, pain medication, physical therapy or steroid injections, among many other measures.

Your Options for Sciatica Surgery

Surgery for sciatica is performed to relieve pressure on nerves and ease pain. Common options include microdiscectomy and laminectomy. There are similarities and differences between the preparations, processes and recoveries for these operations. Here’s what you should know.

Sciatica Surgery Option 1: Microdiscectomy (Discectomy)

During a microdiscectomy, part or all of your herniated disc is removed. Research suggests this will effectively relieve pain in about 80 to 95 percent of patients.

Herniated discHow a herniated disc crowds the spinal canal and causes compression of the sciatic nerve roots

This operation takes place in a hospital or surgery center and typically requires around one hour to complete; you will be given general anesthesia so you don’t feel any pain throughout. Make sure to follow your healthcare team’s directions leading up to the procedure, including restrictions on eating and drinking. If you feel ill the day-of, it’s critical that you alert a provider.

To begin your procedure, a surgeon will make an incision over the affected disc in your spine. Skin and tissue covering the disc will then be moved for better access to the area; some bone may be taken out(a procedure called a laminotomy), as well. Once the path is clear, your surgeon will use tools to remove all or part of the dysfunctional disc.

After removal is finished, your surgeon will close the incision and relocate you to a recovery room for observation. To speed healing, it’s often recommended that patients begin walking within hours of surgery.

Most people will go home the same day following a microdiscectomy. Infrequently, some patients will have to stay at the hospital overnight. Make sure someone is available to drive you home, as you will not be allowed to operate a vehicle the same day.

Surgery Option 2: Laminectomy 

The lamina is the back part of the vertebrae that helps to protect the spinal canal. During laminectomy, both sides of the laminae are removed, along with the spinous process in the middle. This procedure relieves pain by opening up space for your nerves.

Preparation for a laminectomy is similar to that of a microdiscectomy. Remember to stick to all provider instructions and alert them to any unusual symptoms the day of your appointment. Each procedure usually takes about one to three hours from start to finish.

For your operation, you will typically lie face-down while your surgeon makes an incision near the affected vertebrae. After moving skin and muscles aside, they will use instruments to remove all or part of the lamina. Bone overgrowth or some spinal disc may also be cut away. The incision will then be stitched or stapled, bandaged, and you will be transported to a recovery room.

As with a microdiscectomy, you will likely start walking the same day. Though some patients can leave the hospital shortly after surgery, a one- to three-night stay may be required for others. Again, you will need a driver to get home.

A laminectomy takes two to three hours to perform. A microdiscectomy is the more appropriate procedure for stenosis caused by a herniated disc. When the stenosis has another cause, such as bone spurs that developed due to arthritis, a laminectomy may be able to help. Most patients who receive a laminectomy are in their 50s or 60s; people who need microdiscectomies can vary in age but are frequently younger.  

Sciatica Surgery Recovery

Once you’re home, you must follow certain rules, no matter what kind of sciatica surgery you had. Remember to keep your incision area clean and beware of lifting heavy objects, bending over, or sitting for a long time. Follow provider instructions to the letter.

These sciatica surgeries are considered to be safe, and complications are uncommon. However, like any operation, they do come with certain risks, including nerve damage, blood clots and infection. Let your provider know about unusual symptoms following your procedure, such as a fever or excess drainage or pain around your incision.

Medication may ease surgery-related pain, and physical therapy can help speed recovery. Many people are able to return to work two to four weeks following their procedure, or six to eight weeks afterwards if their job is physically strenuous.

Physical therapy sciatica surgeryPhysical therapy can speed recovery after sciatica surgery

After your surgery, you are not going to instantly feel better. Depending on the complexity of your spine surgery, you may be sitting upright the same day and likely walking within 24 hours. A short course of pain medications help your manage postoperative pain.

You will receive instructions on how to carefully sit, rise, get out of bed, and stand. It's important to give your body time to heal, so your doctor may recommend that you restrict your activities: in general, don't do anything that moves your spine too much. You should avoid contact sports, twisting, or heavy lifting while you recover.

After surgery, be vigilant. Report any problems—such as fever, increased pain, or infection—to your doctor right away.

Will Spine Surgery Relieve Sciatica?

While most patients see a big improvement following sciatica surgery, it doesn’t work for everyone. A small percentage continue to feel discomfort in the weeks and months afterward. It’s also possible for sciatica to return down the line in another location.

Ultimately, if you have sciatica and conservative treatment isn’t making much of a difference, surgery may be an option. Your provider can help you decide if it’s the right choice for you.

Have you tried everything for your sciatica but it just won’t quit? Find a spine surgeon who may be able to help.

Updated on: 06/19/20
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