Is Surgery the Last Resort for Sciatica?

Sciatica Surgery: When Is It Necessary, and What Are the Alternatives?

Sciatica is a common condition that affects up to 40% of people at some point in their lives. It is characterized by pain, numbness, tingling, or weakness that radiates from the lower back, buttock, or hip, down the back of the leg, to the foot. Sciatica is caused by compression or irritation of the sciatic nerve, the longest and thickest nerve in the body, which originates from the lower spine and branches into the legs.

Sciatica can have various causes, such as a herniated disc, spinal stenosis, spondylolisthesis, piriformis syndrome, or pregnancy. The severity and duration of sciatica symptoms can vary from person to person and may range from mild and occasional to severe and chronic. Sciatica can interfere with daily activities, such as sitting, standing, walking, or sleeping, and it can significantly affect quality of life and overall wellbeing.

Many people who suffer from sciatica wonder if surgery is the only option to relieve their symptoms and restore their function. In this article you will learn the different types of surgery for sciatica as well as some alternative treatments that may reduce sciatica pain and improve mobility.

Conservative Treatments for Sciatica

Conservative treatments are the preferred options for most cases of sciatica, especially if the symptoms are mild to moderate and do not affect bowel or bladder function or strength or sensation in the leg. There are some alternative treatments that may reduce sciatica pain and improve function without the need for surgery. Some of these treatments are:

• Medication – There are various types of medication that can relieve sciatica pain, such as anti-inflammatory drugs, muscle relaxants, nerve pain medications, and opioids. However, these medications may have side effects or interactions with other drugs, so they should be used with caution and under medical supervision.
• Physical therapy – This is a form of treatment that involves exercises, stretches, massage, heat, cold, ultrasound, electrical stimulation, and other modalities to improve the strength, flexibility, and mobility of the spine and the affected leg. Physical therapy can also help correct posture, alignment, and movement patterns that may contribute to sciatica.
• Injections – These are procedures that involve injecting a steroid, anesthetic, or other substance into the spine or the surrounding tissues to reduce inflammation, pain, and nerve irritation. Injections can provide temporary or long-term relief depending on the type and frequency of the injection.
• Alternative therapies – These are therapies that involve natural or holistic methods to treat sciatica, such as acupuncture, chiropractic, yoga, meditation, biofeedback, and herbal remedies. These therapies may reduce stress, relax muscles, increase blood flow, or stimulate the body’s natural healing mechanisms.

When Is Surgery Recommended for Sciatica?

Surgery for sciatica is usually considered as a last resort when other treatments have failed to provide adequate relief or when there are signs of serious nerve damage or spinal instability. Some indications for surgery are:

• Severe or persistent pain that does not respond to conservative treatments 
• Neurological deficits such as weakness, numbness, tingling, or loss of reflexes in the affected leg or foot
• Cauda equina syndrome, which is a rare but serious condition that occurs when the nerve roots at the end of the spinal cord are compressed. This can cause symptoms such as loss of bladder or bowel control, sexual dysfunction, saddle anesthesia (numbness in the inner thighs), or paralysis.
• Progressive spinal deformity such as scoliosis (curvature of the spine) or spondylolisthesis (slippage of one vertebra over another)

Types of Surgery for Sciatica

There are two main types of surgery for sciatica: decompression surgery and fusion surgery. Decompression surgery aims to remove the pressure on the sciatic nerve by removing part of the disc, bone, or soft tissue that is compressing it. Fusion surgery aims to stabilize the spine by fusing two or more vertebrae together with screws, rods, or cages.

Decompression surgery can be performed in different ways, depending on the cause and location of the nerve compression. Some common types of decompression surgery are:

• Microdiscectomy – This is a minimally invasive procedure that involves making a small incision in the back and using a microscope and special instruments to remove part of the herniated disc that is pressing on the nerve.
• Laminectomy – This is a procedure that involves removing part of the lamina, which is the bony arch that covers the spinal canal. This creates more space for the nerve and reduces inflammation.
• Foraminotomy – This is a procedure that involves enlarging the foramen, which is the opening where the nerve exits the spine. This relieves the pressure on the nerve and increases blood flow.

Fusion surgery can also be performed in different ways, depending on the extent and location of the spinal instability. Some common types of fusion surgery are:

• Anterior lumbar interbody fusion (ALIF) – This is a procedure involving a frontal approach to the spine, where the disc between two vertebrae is removed. Subsequently, a bone graft or artificial device is inserted to fuse the vertebrae. 
• Posterior lumbar interbody fusion (PLIF) – This procedure employs a posterior approach to the spine, entailing the removal of the disc between two vertebrae. Following this, a bone graft or artificial device is introduced into the disc space for vertebrae fusion. 
• Transforaminal lumbar interbody fusion (TLIF) – TLIF utilizes a lateral approach to the spine, involving the removal of a portion of the disc between two vertebrae. A bone graft or artificial device is then placed in the disc space to facilitate fusion between the vertebrae.

Choosing the Best Treatment 

The best treatment for sciatica depends on several factors, such as:

• The cause and type of sciatica – Different causes and types may respond differently to different treatments. For example, sciatica caused by a herniated disc may benefit more from a discectomy, while sciatica caused by spinal stenosis may benefit more from a laminectomy.
• The severity and duration of sciatica symptoms – Severe or persistent symptoms may require more aggressive or invasive treatments. For example, sciatica that causes severe pain, weakness, or numbness or that lasts longer than six weeks may warrant surgery, while sciatica that causes mild pain, tingling, or stiffness or that resolves within a few weeks may be managed with conservative treatments.
• The response and preference of the patient – Different patients may have different expectations, goals, and values regarding their treatment. For example, some patients may prefer to avoid surgery and opt for conservative treatments, while others, especially those experiencing the last stages of sciatica, may prefer to have surgery and achieve faster or more lasting relief.

Surgery for sciatica is one of the options to treat this condition, but it is not always necessary or suitable for everyone. Surgery is usually recommended as a last resort when other treatments have failed or when there are signs of serious nerve damage or spinal instability. There are also alternative treatments that may reduce sciatica pain and improve function without the need for surgery. If you suffer from sciatica, you should consult your doctor to find out the best treatment option for your case.

Patients who have had discectomies for herniated discs may experience sciatica if their discs reherniate, which often occurs if there is a large hole in the outer ring of the disc after surgery. Fortunately, there is a new treatment shown to reduce the risk of reherniation by closing the hole in the disc after a discectomy. This treatment is done immediately following the discectomy—during the same operation—and does not require any additional incisions or time in the hospital. Barricaid was proven 95 percent effective in a study of over 500 patients, meaning 95 percent of patients did not experience a reoperation due to reherniation in a 2-year study timeframe.

If you have any questions about the Barricaid treatment, ask your doctor or contact us.

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