Sciatica and Surgery - Do You Need It?

Usually, surgery for sciatica is considered a last resort sciatica treatment and is generally only recommended when a lengthy treatment using other sciatica treatment options has been unsuccessful. Some cases of chronic sciatica respond well to sciatica surgery, especially when the cause has been identified, as in the case of a herniated disc. Your doctor will help you decide if you need to have sciatic surgery.

Who needs surgery for sciatica?

Sciatica surgery will usually only be considered when the patient's symptoms are severe and debilitating, when the symptoms are getting worse over time, when they have not responded to conservative sciatica treatments, when neurological function is affected and when the cause of the sciatica pain has been clearly identified. Patients who experienced loss of bladder or bowel control often need emergency surgery.

The type of surgery that will be considered will depend on the individual case and is determined by the cause of the symptoms. Some of the surgical procedures include:

• Laminectomy is the sciatica surgical treatment used in cases of spinal stenosis. Between 70% to 80% of patients experience relief after this kind of surgery.
• Fusion surgery is used to fuse vertebrae that have slipped out of place, so that the spine is in the correct alignment and there is no pressure on the sciatic nerve.
• Discectomy is used to remove part of a herniated disc, where it is protruding from between the vertebrae and causing irritation to the sciatic nerve.
• Micro-discectomy or micro-decompression – this procedure is similar to a discectomy but it is much less invasive because the surgeon works through a small incision, using micro-surgical techniques. Recovering time is much less than with a discectomy. About 90% of patients get relief from sciatica symptoms after this type of surgery.
  

Are there any risks with sciatica surgery?

All surgical procedures carry some risk because they are, by nature, invasive. Make sure you fully understand the potential risks, and the implication of these risks, before you consent to the surgery. Remember that sciatica surgery is surgery on your spine. Some of the risks associated with spinal surgery include:

• There is a 10% chance of infection after surgery which may require further surgery to treat.
• With fusion surgery, there is a 2% chance of the fusion failing which will require additional surgery.
• There is a slight chance (about 0.6%) of your spinal cord being damaged during spinal surgery. The result of this could range from some muscle weakness to partial paralysis. The bowel and bladder might also be affected.

What can I expect with post-surgery recovery?

While you will probably be out of bed within the first 24 hours after spinal surgery, don't expect instant results and relief from pain. Analgesics will be prescribed for you for the following 3 or 4 weeks after surgery to give your body time to heal properly. Hospital staff and physical therapists will teach you how to stand, sit and move between the two positions. Some movements and activities will be restricted as you need to rest your spine and the associated muscles until healing has taken place.

Be aware of any changes that may occur in the weeks after surgery like increased pain, fever or infection and report these to your doctor immediately. Full recovery may take several weeks so it is wise to follow instructions to ensure your future health.

Before having sciatica surgery, you will need all the information you can get and then weight up the benefits against the risks. At the end of the day, the final decision is nearly always yours; there are very few sciatica cases that require emergency surgery in which you have little choice.