How to know when you need surgery for sciatica pain relief

Sciatica is a common condition involving radiating pain down one or both legs. This is predominantly caused by degenerative disc disease, particularly disc herniation with compression of spinal nerve roots. Additional causes of sciatica include lumbar spinal stenosis or spondylolisthesis resulting from degenerative arthritis. Sciatica and low back pain are not the same thing, although they're often referred to together.

'Sciatica can generally be managed by your primary care provider,' says Scott Rushton, MD, an orthopaedic spine surgeon at Main Line Health. 'Most cases of sciatica improve with conservative treatment within three months, but for a small percentage of patients, sciatica may continue to be painful and disabling and surgery for sciatica pain relief may prove to be the best option.'

Can surgery relieve sciatic pain?

Yes, surgery can relieve sciatic pain. While lumbar (lower back) surgery may sound like an extreme option, it can actually be an effective way to treat spine-related symptoms in those who otherwise suffer, regardless of treatments they've received.

Qualifying patients are generally those whose sciatic pain has an identified cause (e.g., spinal nerve compression). To be a potential candidate for surgery, one of the following qualifications must also be met. Sciatica has:

• Failed to respond to an appropriate amount of nonsurgical therapy
• Returned after successful response to nonsurgical therapy
• Has become more challenging or has worsened
• Caused increased neurologic problems (such as weakness or paralysis)

For more immediate pain relief, surgery for sciatica has proven more effective than nonsurgical approaches. Surgery for sciatica pain relief has further shown significant improvement in symptoms over the long term. (For patients with persistent low back pain without a known cause or signs of radiculopathy, however, surgery is no more effective than intensive rehabilitation.)

Adds Rushton, 'Although symptoms often improve with prolonged, nonsurgical care, surgery for sciatica offers faster relief from disabling symptoms. Patients who have surgery for sciatica generally get back to improved function and quality of life more quickly.'

What's the difference between axial pain and radicular pain?

Patients often have axial as well as radicular low back pain, but in fact, these are two distinct syndromes requiring different treatment approaches.

Axial low back pain is an example of pain that has no identifying cause. Axial pain may be 'referred' to or spread to different areas of the lumbar region.

Radicular low back pain does have an identifying cause. It is pain that radiates from a spinal nerve root in the lower back. Sciatica is radicular pain involving the sciatic nerve, which is a massive nerve formed by motor and sensory nerve 'fibers.' These fibers come from spinal nerves L4 to S1.

If you've been dealing with sciatica and wondering if surgery for sciatic pain relief is right for you, discuss your concerns with your primary care physician. Your doctor may recommend an experienced spine surgeon who can expertly assess your condition and provide the latest treatment options for sciatica, including surgery, if appropriate.

Main Line Health serves patients at hospitals and health centers throughout the western suburbs of Philadelphia. To consult with Dr. Rushton, please call 610.642.3005.

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