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School of Medicine
5 Questions to Answer Before Considering Sciatica Surgery
Sciatica is the type of pain that originates in your lower back and typically radiates down one or both of your legs. It results from the inflammation of the sciatic nerve in your lower back. The medical term for sciatica is lumbar radiculopathy: pinching of a nerve as it exits the spine.
Surgery is one of the treatment options for sciatica, but it’s not for everyone. Below are some important questions to consider before making your decision, addressed by orthopaedic surgeon Brian Neuman.
Q: Do you know what causes your sciatica?
A: Sciatica may have a variety of causes, each of them requiring a slightly different treatment. Whether or not surgery would get rid of your sciatica will depend on why the sciatic nerve is inflamed in the first place. Possible reasons may include:
- A herniated disc in your lower back
- Spinal stenosis – narrowing of the space inside the spinal canal
- Spondylolisthesis – slipped and misaligned vertebrae
- Degeneration of the spine due to wear and tear, which may result in bone spurs (areas of extra bone growth)
- A cyst or a tumor in the spine
Although most of these causes can be addressed with surgery, it is rarely the first line of treatment. The type of surgery would depend on the problem.
In addition, sciaticalike pain may result from irritation of the sciatic nerve by the piriformis muscle in the buttock. This condition is called piriformis syndrome and rarely requires surgery.
Q: How is sciatica affecting your quality of life?
A: Sciatica pain may extend all the way from the lower back, through the back of your thigh, to your foot. The pain can come and go, sometimes lingering for days and even weeks. This may cause anything from mild discomfort to making the simplest tasks intolerable. Sitting could be painful with sciatica — and driving even more so. Not to mention playing sports and being active.
As you contemplate surgery for sciatica, consider how much the pain affects your quality of life. If your work, hobbies, social life or relationships suffer from your being in constant pain, it may be time to think about surgery.
Although sciatica starts as nerve inflammation, it may eventually progress to nerve damage. If the sciatic nerve is damaged, it could result in numbness, tingling and, in more severe cases, weakness in the knees or legs. The longer it is left untreated, the longer it will take for numbness and weakness to go away, and they may become permanent.
Q: Which treatments have you already tried?
A: There are several ways to manage sciatica without surgery, depending on the cause. They may include pain relief medications, steroid injections, physical therapy, aquatic therapy, meditation and nerve blocks, among others. What works for one person may not be as effective for someone else.
There are several types of doctors who treat sciatica pain. If you feel like you have exhausted your options with your primary care physician, consider making an appointment with a rehabilitation physician or a pain medicine specialist before calling a surgeon. Because every person experiences pain differently, it often takes working with the right specialist to find the combination of treatments that works for you.
Q: What are your goals for this surgery?
A: Making a decision about sciatica surgery when you are in a lot of pain can be tough. Be sure to discuss with your surgeon the postsurgery goals, especially those around pain and activity. Are you expecting to go back to work and the gym in a week? Are you hoping the pain will be gone entirely and for good?
Although most people experience up to 90 percent improvement in their pain levels after a sciatica surgery, no doctor can guarantee this. Numbness may still be present after the surgery, and there is always a chance of sciatica coming back at another vertebra.
Depending on the type of sciatica surgery, most people are walking the next day, and full recovery typically takes two to four weeks. Minimally invasive surgery usually means faster recovery, but if the surgery involves more than one vertebra or disc, your back may take longer to heal.
Q: Do the benefits outweigh the risks?
A: Like most surgeries that require general anesthesia, sciatica surgery comes with the risk of blood clots and heart attack. Infection is also a risk with most surgeries. And since this particular operation involves tissues around a nerve, nerve injury is a possibility.
In addition to the general surgery risks, there may be risk factors specific to your background, lifestyle or state of health. Doctors call them comorbidities. They may increase your risk during the surgery or affect how successful the surgery is in relieving your sciatica pain. Studies have shown that factors such as smoking, high blood pressure, diabetes and duration of the sciatica pain before surgery may affect the outcome of the procedure.If you are seriously considering sciatica surgery, it’s important to partner with a surgeon who would look beyond your physical symptoms and help assess many other factors that may influence your decision.