Whether or not surgery is recommended or appropriate for sciatica depends on the cause of this type of nerve-related irritation and the severity of the discomfort. If the source is a herniated disc in the lower back area, the most common surgery performed is a discectomy or a less invasive version of the same procedure known as a microdiscectomy. This article discusses possible options with surgery for sciatica-related pain.
Discectomy or Microdiscectomy
A discectomy is a decompression procedure performed to relieve sciatic nerve pressure by removing the material protruding from the disc that is affecting the sciatic nerve. While there are times when this type of surgery may be performed with traditional methods, it is typically done using minimally invasive techniques. In this case, a microdiscectomy is performed with smaller incisions.
A spinal fusion does not specifically address sciatic pain, since it is not a nerve decompression procedure. However, it may be necessary when a discectomy is performed if all or most of the disc needs to be removed and the spine becomes unstable. Fusion surgery involves the insertion of special hardware along with bone graft material to "fuse" or join adjacent vertebrae together. Efforts are usually made to avoid the need for this procedure whenever possible, since it is more invasive. This is why it is more common for a microdiscectomy to be the recommended surgery for sciatic pain.
Abnormal spinal narrowing, referred to as spinal stenosis, is sometimes a source of sciatica pain. Should this be the case, the most common surgical solution is a procedure known as a laminectomy. This involves the removal of a portion of the back part of a spinal bone called the lamina, creating more space for the portion of the sciatic nerve being compressed by the narrow spinal canal. A laminectomy may also be performed if an abnormal bone growth known as an osteophyte, or "bone spur," is the source of sciatic nerve pain.
When Surgery May Be Recommended
Keep in mind the general requirement for spinal surgery is the presence of a structural source of the related symptoms. With sciatica, this is often a herniated disc. Also, unless symptoms are severe or potentially life-threatening, patients are normally encouraged to try physical therapy, medication, lifestyle adjustments, and therapeutic exercises before surgery is even considered. Surgery for pain related to the sciatic nerve may be recommended if the following circumstances apply:
• Nonsurgical remedies have not been effective for several months
• Sciatica is affecting both legs—referred to as bilateral sciatica
• An infection has developed in the pelvic area that is affected by sciatica
• There is disc-related damage other than herniation
• A cyst or tumor irritating the sciatic nerve needs to be removed
Surgery is also likely to be required if there is a medical emergency related to your sciatica. One possibility is the compression of a bundle of nerves at the base of the spine known as the cauda equina.
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 the 2-year study timeframe.
If you have any questions about the Barricaid treatment, ask your doctor or contact us at 844-288-7474.
For full benefit/risk information, please visit: https://www.barricaid.com/instructions.