Sciatica -- Surgical Management

Spine surgery is considered when the sciatica pain is severe and has not gotten better within six to twelve weeks. Depending on the cause and the duration of the sciatica pain, one of two surgical procedures will typically be considered: a microdecompression (microdiscectomy) or an open decompression (lumbar laminectomy).

Microdiscectomy (microdecompression)

- Sciatica pain is due to a disc herniation
- After four to six weeks if the pain is not relieved by non-surgical means OR if the patient’s pain and disability is very severe.
- Urgent surgery is only necessary if the patient experiences progressive weakness in the legs, or sudden loss of bowel or bladder control.
A Microdiscectomy is typically an elective procedure, and 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.
Approximately 90% to 95% of patients will experience relief from their sciatica pain after this type of surgery.

Lumbar laminectomy (open decompression) for sciatica
- Sciatica pain is due to Lumbar spinal stenosis
- Surgery may be offered if the patient’s activity tolerance falls to an unacceptable level.
Again, surgery is elective and need only be considered for those patients who have not gotten relief from the sciatica after pursuing non-surgical treatments. The patient’s general health may also be a consideration.
After a lumbar laminectomy (open decompression), approximately 70% to 80% of patients typically experience relief from their sciatic nerve pain.

In 2005 the FDA approved a new surgery designed to relieve symptoms of lumbar spinal stenosis called the X Stop. This procedure involves placing an implant in the very back of the spine that prevents the patient from leaning backwards, a position that typically causes pain in patients with lumbar spinal stenosis.

www.spine-health.com/conditions/back-pain/comprehensive-management-piriformis-syndrome-and-sciatica-pain