Why Surgery for Sciatica Is Not One-Size-Fits-All

Many individuals find that surgery offers successful relief from their symptoms of debilitating sciatica. The type of surgery recommended can differ greatly and rely on the underlying cause of sciatica. Typically, getting surgery for sciatica is elective, which means it is the patient’s preference whether to have surgery or not.

Here are possible explanations why the treatment of sciatica could be prescribed for surgery, as well as insights into why the same form of surgery may not be right for everybody.

Symptoms of sciatica

Sciatica symptoms can vary from unusual and annoying to extreme and debilitating. Symptoms rely on the particular root of the spinal nerve which, at the origin of the sciatic nerve, is irritated and/or compressed. Together, one or more nerve roots may be affected. While some symptoms are nerve root specific, other symptoms are normal in sciatica.

Popular Symptoms of Sciatica:

Sciatica typically affects just one leg at a time, and symptoms are radiated to the thigh and down the leg from the lower back or buttock. The front, back, and/or sides of the thigh and leg can cause pain from sciatica. The following are a few common symptoms seen in sciatica:

*Pain. Pain with Sciatica can be continuous or sporadic. Typically, the pain is defined as a burning feeling or a sharp, shooting pain. Compared to the back, the pain is typically more intense in the knee. Leg pain is typically more common in the area of the calf below the knee than in other areas of the leg.

*Sensation modifications. The back of the leg can experience numbness, tingling, and/or a pins-and-needles feeling.

*Weakness. In the leg and foot, weakness can be sensed. In the affected leg, a feeling of heaviness can make it difficult to lift the foot off the floor.

*Changes in posture can exacerbate or alleviate pain. Sciatic pain can be caused by such postures:

o When sitting, trying to stand up, standing for a long time, bending the spine forward, twisting the spine and/or when coughing, the pain of sciatica can feel worse.

o While lying down, pain may increase or remain constant, causing disrupted sleep, lying on the back with the knees slightly elevated and supported by a pillow, or lying between the legs on the side with it, may help alleviate the pain in such cases.

o While walking, applying a heat pack to the rear pelvic area, or doing pelvic exercises, the pain may be relieved.

Types of Sciatica:

Sciatica can be of various kinds, depending on the length of symptoms and whether legs are affected:

Acute Sciatica. A new onset, 4 to8-week period of sciatic nerve pain is acute sciatica. The pain may be self-managed and medical attention may not usually be needed.

Chronic Sciatica. Chronic sciatica is a chronic pain in the sciatic nerve that lasts more than 8 weeks and does not normally subside with self-management.

Depending on the source, nonsurgical or surgical treatment can be needed for chronic sciatica.

Alternating Sciatica. Alternating sciatica is sciatic pain in the nerve that alternately affects both legs. This type of sciatica is unusual and can result from the sacroiliac joint’s degenerative problems.

Bilateral Sciatica. Bilateral sciatica develops jointly in both legs. This form of sciatica is uncommon and can occur at many spinal levels due to degenerative changes in the vertebrae and/or disc, or severe conditions such as cauda equina syndrome.

Do I need surgery to cure my symptoms of Sciatica?

Surgery may be needed when serious underlying conditions such as cauda equina syndrome, tumors, infections, or extreme herniation of the lumbar disc are caused by sciatica.

Surgical treatment of these conditions helps protect the function of the leg and increases the quality of life.

· Surgery may be a choice to consider in other circumstances, such as when:

· Extreme pain in the leg and/or foot is followed by gradual neurological signs, such as fatigue and/or numbness.

· Different combinations of options for nonsurgical care, including physical therapy, oral drugs, and injections, have been attempted.

· Leg functioning is significantly reduced, such as the performance of everyday household activities and/or occupational activities is significantly impaired.

Surgery is usually considered after 6 to 8 weeks of non-surgical care without treating a medical emergency.

What choices for surgery do I have for the treatment of sciatica?

Depending on the position and causes of the impingement, a pinched nerve root can be treated in many different ways, for example.

Popular Sciatica surgical procedures include:

· Microdiscectomy. A small portion of the disc material taken out in this operation to relieve compression of the nerve root.

· Lumbar Decompression. It is possible to alleviate pressure on nerve roots by:

o Laminectomy, to make more space for the spinal nerves, most or all of the lamina (posterior most of the vertebra) is removed.

o Foraminotomy. By trimming the overgrown bone, the neuroforamina (bony openings for spinal nerves) are widened, making more space for the nerve roots as they exit the spinal canal.

Sciatica operation is typically minimally invasive and performed with tiny incisions. Open procedures that use wider surgical incisions, Such as open lumbar laminectomy (open decompression), can be done for extreme nerve compression with several triggers. To prevent the worsening of symptoms, it is best to treat sciatica as early as possible.

What is the standard long-term outlook for surgery after sciatica?

Although surgery can offer immediate pain relief from sciatica, studies suggest that both nonsurgical and surgical therapies can provide similar outcomes after a 1-to 2-year span.

The outcome of the surgical operation often depends on other factors, in addition to the form and severity of the underlying cause, such as age, smoking, and prior history of sciatica. It is important to remember that sciatica surgery is normally targeted at improving leg pain and function.

After sciatica surgery, localized lower back pain does not improve.

Your doctor may help you understand the options available and possible results if you are considering surgery for your symptoms of sciatica. A doctor may also provide advice on the proper timing for surgery and whether there is a need to explore nonsurgical options in advance.