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When to Consider Sciatica Surgery?

Sciatica pain is no joke. Originating in your lower back, it can radiate down your hips, buttocks, legs, and even into your feet. It’s estimated that about 40 percent of people will experience sciatica over the course of their lives, and for some, it can be quite debilitating. Though most cases will resolve over time, persistent or severe sciatica often requires some type of medical intervention. But how do you know if your sciatica is significant enough to warrant surgery? Here, we’ll discuss some important signs you should consider saying yes to surgery.

Your primary care doctor has recommended you see a spine specialist.  

If you’re like most people, when you first develop a medical concern, you make an appointment with your primary care doctor. And this is a good first step. Your primary care physician can perform a physical exam, order imaging studies, and diagnose and treat sciatica. But if your case is more complex, you may be referred to a spine surgeon. Keep in mind, seeing a surgeon doesn’t mean you will definitely require surgery. It’s just the next step in the process of finding the best treatment plan for you.


Non-surgical measures to treat your sciatica haven’t worked.  

Sciatica symptoms appear when pressure is placed on your sciatic nerve as it leaves your lower back and runs down your leg. This is often caused by problems with your lower spine, such as a herniated disc or a bone spur. Sciatica can often be treated without surgery. Common treatments include anti-inflammatory medications, muscle relaxants, heat/ice application, and physical therapy. Epidural steroid injections can also be given for more severe cases to help decrease inflammation directly around the sciatic nerve. However, if your pain remains despite these interventions, sciatica surgery may become a more viable option.


Your quality of life is suffering because of your sciatica.

Nobody wants to be in pain, but sometimes we choose to bear it longer than we should because we’re scared of the steps that need to be taken to remedy it. So stop for a moment and be honest with yourself. Is your sciatica impacting your ability to work? Are you unable to enjoy your favorite hobbies or activities? Is it affecting your relationships?  These may be signs that it’s time to think about surgery. 

According to a study in the New England Journal of Medicine, pain relief was twice as fast among patients who had early sciatica surgery compared to those who went through conservative treatments first. If you’re really suffering, why prolong it?


You’ve been told you are a candidate for a minimally invasive sciatica surgery.

Spine surgery has come a long way. Two of the most common surgeries for sciatica, microdiscectomy and lumbar laminectomy, can now be performed using minimally invasive techniques, rather than the traditional, open surgeries that most people think of. Minimally invasive surgery results in quicker recoveries and fewer complications. Many patients are out of bed within the day and report significant pain relief within weeks.  

You’re experiencing “red flag” sciatica symptoms.

Most times, sciatica surgery is an elective procedure and is performed to simply help you feel better. Yet there are times when surgery becomes more of an urgent—or possibly even emergent—need. Things to watch for include:

  • Loss of bladder or bowel control
  • Progressive weakness or numbness in the legs

Be sure to notify your doctor right away if any of these develop. Such symptoms can indicate significant nerve damage. In cases like this, sciatica surgery can be the key to avoiding permanent damage. 

Surgery is never something to be taken lightly, but there are times when it is the best decision. Take a mindful approach and work in partnership with your doctor. You’ll be certain to come to the best decision for your sciatica management.

Hear from a DISC Patient who overcame sciatica via surgery:


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Rojeh Melikian, M.D.

About the author

Rojeh Melikian, M.D. Dr. Rojeh Melikian is a Harvard and Emory University-trained orthopaedic spine surgeon. He was subsequently accepted into the prestigious Harvard Combined Orthopaedic Surgery Residency Program, where he excelled and was appointed as Chief Resident at the Massachusetts General Hospital. He received extensive training in complex spinal surgery, scoliosis, as well as primary and metastatic spine tumors. Upon graduation, Dr. Melikian was awarded the prestigious Harvard Orthopaedic Surgery Thesis Day Award for best clinical presentation for his work on spinal infections. Dr. Melikian has authored numerous presentations, posters and journal articles on spine surgery. Read more articles by Rojeh Melikian, M.D..

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