Urgent surgery is typically only necessary if the patient experiences progressive weakness in the legs, or sudden loss of bowel or bladder control, which may be caused by cauda equina syndrome.
Depending on the cause and the duration of the sciatica pain, one of two surgical procedures will typically be considered:
In cases where the sciatica pain is due to a lumbar disc herniation, a microdiscectomy or small open surgery with magnification may be considered. In this surgery, only the portion of the herniated disc that is pinching the nerve is removed - the rest of the disc is left intact.
This surgery is generally considered after 4 to 6 weeks if the severe pain is not relieved by non-surgical means. If the patient’s pain and disability is severe, surgery may be considered sooner than 4 to 6 weeks.
As a general rule, approximately 90% to 95% of patients will experience relief from their sciatica pain after this type of surgery.
In cases where the sciatica pain is due to lumbar spinal stenosis, a lumbar laminectomy may be recommended. In this surgery, the small portion of the bone and/or disc material that is pinching the nerve root is removed.
Laminectomy surgery may be offered as an option if the spinal stenosis causes the patient’s activity tolerance to fall to an unacceptable level. The patient’s general health may also be a consideration in whether or not to have surgery.
After a lumbar laminectomy (also called an open decompression), approximately 70% to 80% of patients typically experience relief from their sciatic nerve pain.
Surgery is the patient’s decision
In most cases, sciatica surgery is elective, meaning that it is the patient’s decision whether or not to have surgery. This is true for both microdiscectomy and laminectomy surgery.
The patient’s decision to have surgery is based primarily on the amount of pain and dysfunction the patient is experiencing, and the length of time that the pain persists. The patient’s overall health is a consideration as well.
There are 6 lower back problems that are the most common causes of sciatica:
A herniated disc occurs when the soft inner core of the disc (nucleus pulposus) leaks out, or herniates, through the fibrous outer core (annulus) and irritates the contiguous nerve root.
A herniated disc is sometimes referred to as a slipped disc, ruptured disc, bulging disc, protruding disc, or a pinched nerve. Sciatica is the most common symptom of a lumbar herniated disc.
While disc degeneration is a natural process that occurs with aging, for some people one or more degenerated discs in the lower back can also irritate a nerve root and cause sciatica.
Degenerative disc disease is diagnosed when a weakened disc results in excessive micro-motion at that spinal level, and inflammatory proteins from inside the disc become exposed and irritate the nerve root(s) in the area.
This condition occurs when a small stress fracture allows one vertebral body to slip forward on another; for example, if the the L5 vertebra slips forward over the S1 vertebra.
With a combination of disc space collapse, the fracture, and the vertebral body slipping forward, the nerve can get pinched and cause sciatica.
This condition commonly causes sciatica due to a narrowing of the spinal canal. Lumbar spinal stenosis is related to natural aging in the spine and is relatively common in adults over age 60.
The condition typically results from a combination of one or more of the following: enlarged facet joints, overgrowth of soft tissue, and a bulging disc placing pressure on the nerve roots, causing sciatica pain.
The sciatic nerve can get irritated as it runs under the piriformis muscle in the buttock. If the piriformis muscle irritates or pinches a nerve root that comprises the sciatic nerve, it can cause sciatica-type pain.
This is not a true radiculopathy (the clinical definition of sciatica), but the leg pain can feel the same as sciatica caused by a nerve irritation.
Irritation of the sacroiliac joint—located at the bottom of the spine—can also irritate the L5 nerve, which lies on top of the sacroiliac joint, causing sciatica-type pain.
The leg pain can feel the same as sciatica caused by a nerve irritation.