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Is surgery an option for sciatica?
Here at Sciatica Help we try to focus on home and natural remedies to treat sciatica. I’ve become to realise though a lot of sciatica sufferers are in so much pain they feel that surgery is now a serious consideration for them.
Although many people may view surgery as a viable option to relieve their sciatica it must be pointed out there is never any guarantees with any medical procedure. From the research I’ve done it does seem clear that surgery will most likely improve your sciatica. However! A lot does depend on certain criteria including:
- The cause of your sciatica – stenosis, trapped nerve, tumour, cyst or a herniated disc will respond differently to surgery.
- The severity of your pain.
- The duration of time elapsed since the surgery. Some studies show post op benefit or relief diminishes over time.
- Lifestyle changes. Surgery is likely to be more successful when used alongside lifestyle changes such as fitness improvement, diet, non-smoking etc.
Some of the above criteria is also likely to affect your GPs assessment as to your suitability for surgery.
What types of surgery?
There are a few different types of surgery that can be performed to relieve sciatica and the main ones are detailed below. Normally referred to as either spinal or lumbar decompression surgery, they all involve creating more space for your sciatic nerve to coexist alongside the various muscles, discs, joints and bones of the spine without impingement!
- Discectomy. A procedure where part of a herniated disc is removed to stop it pressing against the sciatic nerve.
- Laminectomy. Where some bone is removed to create more space.
- Spinal fusion. Where two vertebrae are fused together with bone graft using rods and screws. This stops the movement between two painful joints.
Who can have surgery?
Well, I suppose the simple answer is “anyone if you’re prepared to pay for it”! Even if you’re willing to go privately there will be an element of caution though. Any surgery carries risks, spinal maybe more so than other types. As mentioned not all types of sciatica will be considered severe enough to warrant surgery. I heard a great quote a well-respected spinal surgeon gave that went something like “surgeons spend 10 years learning how to operate but then they should spend the next 25 years learning how not to operate!” What this means is that a surgeon will ensure you have gone through all available non-surgical treatments (and consider how well you’re likely to react to surgery) before agreeing to carry out any operation.
Although available on the NHS it will only be considered as a last resort really. All GPs know that most cases of sciatica will respond well to non-surgical treatment anyway, so are unlikely to put you forward for surgery unless you’ve had chronic sciatica for a number for years.
Oswestry Disability Index
One of the ways healthcare professionals measure who is suitable for surgery is to get patients to complete an Oswestry Disability Index. This is a questionnaire the patient fills in to answer areas of their lives that is affected by their sciatica. It covers ten areas like standing, sitting, walking, social life etc.
You select 1 of 6 possible statements depending on the severity of your pain and how it impacts on your life. An example is:
Section 5 – Sitting
- I can sit in any chair as long as I like
- I can only sit in my favourite chair as long as I like
- Pain prevents me sitting more than one hour
- Pain prevents me from sitting more than 30 minutes
- Pain prevents me from sitting more than 10 minutes
- Pain prevents me from sitting at all
There are 10 sections altogether. A particular formula is used to generate your score as a percentage and from this your level of disability will be given ranging from minimal to bed bound.
You can download your own Oswestry Disability Index here.
Should I see a neuro or orthopaedic surgeon?
Either will be suitable for back surgery but it’s important to see a surgeon who specialises in spinal surgery – regardless of if they’re a neuro or orthopaedic surgeon.
Will surgery cure my sciatica?
Sciatica responds well to both surgical and non-surgical treatments. There is evidence to show that surgery will have a greater effect than non-surgery though. In an extensive study involving nearly 500 lower back pain and sciatica sufferers, after 12 months both surgical and non-surgical patients reported an improvement in symptoms. However, surgically treated patients reported much greater improvement. For the main symptom, either leg or back pain, 71% of surgically treated and 43% of nonsurgical treated patients reported definite improvement.
See The Maine Lumbar Spine Study, 1-year outcomes of surgical and nonsurgical management of sciatica.
Also see Estimates of success in patients with sciatica due to lumbar disc herniation.
Where can I find out more about surgery for sciatica?
Most of the main private health care providers will be a good place to start as well as specialist spine clinics.
“When told by my GP that nothing could be done for my sciatica I doubted anything would ever help. I now lead a pain free life”!