Can Sciatica Come Back after a Discectomy?

Is It Possible for Sciatica to Return Following Discectomy?

Sciatica is a condition that causes pain, numbness, tingling, or weakness in the lower back, buttocks, and legs due to the compression or irritation of the sciatic nerve. The sciatic nerve is the largest and longest nerve in the body, and it runs from the lower spine, through the pelvis, and down the back of the legs.

One of the most common causes of sciatica is a herniated disc, which occurs when the soft inner core of a spinal disc bulges out through a tear or a crack in the tough outer layer and presses on the nearby nerve root or the spinal cord. 

A discectomy is a surgical procedure that removes part or all of a herniated disc that is causing sciatica. The procedure can relieve the symptoms, especially in the last stages of sciatica, by decompressing the nerve and reducing the inflammation. However, a discectomy does not guarantee a permanent cure, and some patients may experience a recurrence of sciatica after the surgery. This article will explore the causes, treatment, and prevention of recurrent sciatica after a discectomy.

Factors Influencing Sciatica’s Return

There are three main reasons sciatica can come back after a discectomy:

• Disc reherniation – One of the primary concerns post-discectomy is the potential for disc reherniation. Despite surgical intervention, there is a chance the disc material may herniate again, causing a recurrence of sciatic symptoms. This risk is higher in the initial months after surgery.
• Scar tissue formation – Scar tissue naturally forms as part of the healing process after surgery. In some cases, excessive scar tissue can develop and put pressure on the sciatic nerve, leading to a reappearance of sciatica symptoms. Physical therapy and careful postoperative management can minimize this risk.
• Adjacent segment degeneration – Discectomy alters the biomechanics of the spine, potentially causing stress on adjacent discs. Over time, this increased stress may lead to degeneration of nearby discs, triggering sciatic nerve compression and a return of symptoms.

Diagnosis and Treatment of Recurrent Sciatica 

The diagnosis and treatment of recurrent sciatica after a discectomy depend on the cause, severity, and duration of the recurrence. Diagnosing recurrent sciatica after a discectomy involves a thorough medical history, physical examination, and imaging tests, such as X-ray, MRI, or CT scan. The objective is to identify the source and extent of the nerve compression or irritation and to rule out other possible causes of sciatica, such as infection, tumor, or fracture.

Treatment for recurrent sciatica after a discectomy involves conservative or surgical options, depending on the response and preference of the patient. Conservative treatment involves medication, physical therapy, injections, or alternative therapies, such as acupuncture, massage, or chiropractic care. 

Surgical treatment for recurrent sciatica after a discectomy involves a revision or a repeat discectomy or a more complex procedure, such as a fusion or a disc replacement. The surgery involves removing the reherniated disc material or other structures that are compressing the nerve and stabilizing or restoring the disc space and the spine’s alignment. 

Preventing and Managing Recurrent Sciatica after a Discectomy

The prevention and management of recurrent sciatica after a discectomy involve lifestyle modifications and follow-up care, such as:

• Avoiding smoking, excessive alcohol, or drug use, which can impair the healing and recovery of the disc and the nerve
• Maintaining a healthy weight to reduce the pressure and strain on the disc and the spine
• Controlling blood sugar to prevent or delay the development of diabetic neuropathy, which can worsen the nerve damage and pain
• Managing stress and mood, which can affect the perception of pain and the immune and inflammatory response
• Following a balanced diet to get the nutrients and antioxidants that can support tissue repair and regeneration as well as nerve function and protection
• Exercising regularly to strengthen the muscles and joints that support the spine and increase blood circulation and oxygen delivery to the disc and the nerve
• Practicing good posture and ergonomics, which can prevent or correct the misalignment or imbalance of the spine and avoid the excessive bending, twisting, or lifting of the spine
• Following the doctor’s instructions and recommendations, which can include taking prescribed medication, attending scheduled appointments, and reporting any problems or concerns that may arise

While a discectomy can offer substantial relief from sciatica, it is essential to acknowledge the possibility of its return. Diligent postoperative care, including rehabilitation, lifestyle modifications, and regular monitoring, plays a pivotal role in minimizing the risk of recurrence. By adopting a proactive approach, individuals can confidently navigate the journey toward lasting sciatic relief.

If you have had a discectomy or microdiscectomy to relieve sciatica caused by a herniated disc, you may experience recurrent sciatica if the disc becomes reherniated, which often occurs if there is a large hole in the outer ring of the disc after surgery. Fortunately, there is a new treatment available to help avoid this. Barricaid is a device shown to reduce the risk of reherniation by closing the hole in the disc after a discectomy, and 95 percent of Barricaid patients did not undergo a reoperation due to reherniation in a 2-year study timeframe. This treatment is done immediately following the discectomy—during the same operation—and does not require any additional incisions or time in the hospital. 

To learn more about the Barricaid treatment, ask your doctor or contact us.

For full benefit/risk information, please visit: https://www.barricaid.com/instructions.