Conservative non-surgical treatment options are our most recommended path for sciatica relief. Non-surgical treatment options for sciatica include physical therapy, chiropractic care, massage therapy, exercises, manipulation, non-surgical spinal decompression, prescription pain medications, steroid injection shots.
When to consider surgery for sciatica?
Surgery for sciatica is only recommended when your chronic sciatica symptoms including low back pain, leg pain, numbness, or muscle weakness fail to resolve through non-surgical treatments, or your symptoms suddenly and rapidly worsen.
Surgery may be recommended under the following conditions:
Cauda Equina Syndrome (CES)
This is a rare, but serious condition caused by dysfunction of the nerve or nerve roots located in the lower back or the lumbar spine. It is considered a serious medical emergency and requires immediate surgery. If you experience sudden and worsening weakness, pain, lose control of your bowel or bladder movement, or sexual dysfunction, you need to seek immediate medical attention.
Tumor
A spinal tumor in the lumbar or the lower back spine can compress the sciatica nerve causing numbness, weakness, pain, or even loss of function. Irrespective of whether the tumor is benign (non-cancerous) or cancerous, if your sciatica is caused due to a tumor, surgery is required to remove it.
Bilateral Sciatica
This is a rare condition in which the sciatic nerve on both sides of the body is compressed, irritated, or inflamed. Bilateral sciatica can occur due to Piriformis syndrome or a herniated disc.
The piriformis muscles located on top of the hip in the buttock region sometimes cause compression on both sides of the sciatic nerve leading to a condition called Piriformis Syndrome and manifested as bilateral sciatica. Rarely a herniated disc bulges and compresses sciatic nerves on both sides causing bilateral sciatica.
Infection
Infection of the nerves in the lower back or pelvic region that causes sciatica may require surgery if the infection doesn’t resolve through prescription medications or steroid injection shots.
What types of surgery procedures are performed for sciatica relief?
Surgical mediation for sciatica is generally focused on treating the underlying cause of your sciatica pain. A herniated disc is one of the leading causes of sciatica. Surgery involves removal of the herniated disc or resolving other medical conditions like the narrowing of the spinal column also referred to as spinal stenosis.
Microdiscectomy
This surgery is performed by removing a small portion of the herniated disc to release pressure on the compressed, irritated, or inflamed sciatic nerves. This is a minimally invasive surgery.
Laminectomy
This is a major surgical procedure that is generally used to treat spinal stenosis. In this procedure, a small portion of the lamina or the full lamina (vertebral bone) is removed. The removal releases pressure on the sciatica nerves and treats your sciatica pain and symptoms.
Facetectomy
The spinal vertebra consists of two sets of facet joints that provide structural stability to the vertebral column. This surgical process removes a portion of the facet thereby increasing the space between the joints and relieving pressure on the compressed nerve.
Foraminotomy
This surgical process helps enlarge the vertebral foramen which leads to relieving pressure on the compressed nerves. The vertebral foramen is the small opening that encloses the spinal cord. Spinal nerves, arteries, and veins also pass through the vertebral foramen.
Spinal Fusion
This surgical process connects or fuses two or more vertebrae to stabilize the spine. Generally, this procedure is performed after the removal of a herniated disc and uses metal implants including plates, screws, and rods to hold or fuse the vertebrae and stabilize the spine.
How long does it take to recover from sciatica surgery?
Recovery from surgery depends on the type of surgical procedure. Typically, if the surgery is more invasive or if multiple procedures are performed, then the recovery time is usually longer. Most back surgery also requires rehabilitation and physical therapy post-surgery.
What are the risks associated with sciatica surgery?
Back surgery is an invasive procedure and comes with the risk of infection, inflammation, and serious side effects. Back surgery involving the removal of intrinsic muscles or bones responsible to provide stability can adversely affect the range of motion of your spine. A study published by the National Library of medicine estimated up to 46% of low back spine surgeries fail.
Surgery vs non-surgical treatment of sciatica
A study by the BMJ concluded that sciatica surgery may provide quicker symptomatic relief from sciatica compared with conservative non-surgical treatment, but there were no major differences in success rate between surgery and non-surgical sciatica pain management long term. It is, therefore, crucial to weigh the risks and benefits of sciatica surgery vs non-surgical treatment of sciatica for effective and long-term pain relief.
Chiropractic care involving spinal manipulation, non-surgical spinal decompression, therapy, exercises, and massage can help safely, non-invasively, and effectively manage your sciatica and help you avoid back surgery.
Contact Cianci Chiropractic to discuss and review options to help you in the treatment of your sciatica pain.