Sciatica Surgery 101: A Guide to Sciatica Surgery

When I was pregnant, I dealt with daily shooting pain on my right side for months. I tried acupuncture, stretching, and chiropractic care, but the nerve pain stubbornly held on for a year after having my baby. This shooting pain was sciatica, and it is quite common. 

Anyone who has felt that sharp burning feeling down the back of their leg knows how much sciatica can affect everyday lives. You’re not alone — up to 40 percent of people have dealt with sciatica at some point in their life. But when would you need sciatica surgery?

We spoke with experts to tell us about why you would need sciatica surgery, your surgical options, and what you can expect before and after sciatica surgery.

What is sciatica?

“Sciatica is a term that usually refers to irritation of the sciatic nerve,” says Timothy Reish, MD, an orthopedic surgeon with Summit Health in New York. The sciatic nerve is the large nerve that runs down your lower back, through your buttock, down the back of your leg, and all the way into your foot. 

Sciatica is described as “pain, burning, tingling and numbness that radiates from the buttock…and sometimes into the foot,” according to the American Association of Neurological Surgeons.  

You might have sciatica if you feel sharp pain in your lower back, buttocks or down your leg.^1,2 Other symptoms of sciatica include:^1,2

• Pain when moving, coughing, or sneezing
• Leg weakness or numbness
• Burning or tingling feeling in your leg

What causes sciatica?

Sciatica is a degenerative condition affecting the spine. Several different health issues that affect your spine and the nerves in the spinal cord may cause sciatica. Two common conditions are bone spurs caused by arthritis and herniated discs. 

Arthritic bone spurs and spinal herniated discs can both compress nerve roots, causing irritation. Bone spurs are outgrowths, or bumps, of bone that can grow near the joints of the lower spinal bones, which get worn down if you have arthritis.⁴

“Most forms of arthritis in the back are degenerative, but there are (also) inflammatory forms of arthritis, which can also lead to inflammation and degradation of the joints around the spine,” says John Minnich, MD, an orthopedic surgeon with Grand View Health in Pennsylvania and medical adviser for Maskad and Revivv brands. Infection of the intervertebral discs or the vertebra of the spine can also break down the joints and discs prematurely.

With a herniated disc, the elastic cartilage and gel between each of the bones in the spine pushes out or “herniates.” This tissue can press on your nerves, causing pain. This pain is known as radicular pain, which occurs when those tissues or bone spurs press on the nerve roots that make up the sciatic nerve. This pain radiates downward to the lower part of the body. This is what you call sciatica. 

Some other reasons you may have sciatica include:

• Lumbar spinal stenosis, which happens when the spinal column becomes narrower and presses on the spinal cord and nerves. This happens more commonly in older people.
• Spondylolisthesis, which occurs when the spinal vertebrae slips out of place
• Muscle spasms in the lower back or pelvic area
• A growth on the spine

Another reason sciatica may occur, such as in my case, is pregnancy. Or, more specifically, when the growing uterus presses down on the sciatic nerve, explains Dr. Minnich. He says it can also happen with hormone changes that relax the ligaments around the spine and pelvis, causing the sciatic nerve to get stretched and irritated. 

Sciatica can have many different causes, and it’s important to make sure your pain isn’t from something more serious, such as a tumor, that could be causing your symptoms. Your health care provider can examine you and help figure out where your pain is coming from.¹ 

Diagnosis and treatment options

To diagnose sciatica, your doctor will ask you questions about your symptoms, general health, and medical history. Most cases of sciatica improve with non-surgical treatments. However, imaging such as X-rays may be done if your pain isn’t responding. Otherwise, images are done if nonsurgical treatments haven’t helped your previously reported symptoms. You may also have an MRI done to find out what’s causing the sciatica, according to Sean Ormond, MD, a pain management specialist at Atlas Pain Specialists in Arizona.

Questions to ask your doctor

If you are reading this, you may have been dealing with sciatica for a while or your sciatica may be severe enough to be considering surgery. When talking with your provider, you may want to think of some questions in advance of your appointment and write them down so you don’t forget. Here are a few to get you started:

• What are the possible causes of my sciatica symptoms?
• How can you confirm if I have sciatica? What tests or exams are necessary?
• Are there any other conditions that could be causing my symptoms?
• What treatment options are available for sciatica?
• Are there any lifestyle changes or exercises that could help alleviate my symptoms?
• How long does it typically take for sciatica to improve with treatment?
• Are there any activities or movements I should avoid to prevent aggravating the condition?
• Are there any potential side effects or risks associated with the recommended treatments?
• Are there any warning signs that my condition is worsening or requires urgent attention?
• Can sciatica lead to any long-term complications if left untreated?

Treatment options

Nonsurgical treatment options can include pain medications, injections, physical therapy, chiropractic care, acupuncture, and massage. Figuring out what the best non-surgical treatment option is should always be considered in partnership with your provider. According to Ormond, there are many factors to think about such as what symptoms you’re having, the results of any images you have taken, and how effective past treatments such as medications or physical therapy have been. Treatment is usually a team approach with a pain specialist, physical therapist, and your provider working with you to create a personalized plan right for you.

Sciatica typically goes away on its own in four to six weeks, even without these treatments. But in some cases, surgery might be needed. Minnich says if nonsurgical treatments haven’t worked, and your pain has persisted for three months, it may be time for surgery. 

Types of Sciatica Surgery 

Sciatica surgery is known as lumbar spinal surgery. This surgery is done to fix the radicular nerve pain or sciatica.

According to Ormond, surgery may be necessary if you have:

• Completed other treatments including physical therapy and pain management, and they didn’t work
• Sciatic pain that’s significantly affecting your everyday life
• Severe sciatic nerve compression that causes muscle weakness or numbness in your lower extremities 
• A loss of bowel and bladder control

The type of surgery you have depends on what is causing the nerve compression. There are many sciatica surgery options.

Discectomy and microdiscectomy

If your sciatica is caused by a herniated disc or bone spurs, you may receive a discectomy, where the surgeon will remove your slipped disc. This is a type of decompression surgery and can relieve the pressure on the nerve. 

Open discectomies use a larger incision on the tissues, whereas a microdiscectomy has a smaller cut and shorter recovery time. “The procedure usually lasts one to two hours, and you can often go home the same day,” explains Ormond.

Microdiscectomy is considered the gold standard for disc herniation surgery because it’s minimally invasive, yet still is effective in taking away sciatic symptoms, explains Ormond. “It has a high success rate for relieving leg pain (sciatica), which is why it’s so commonly recommended,” Ormond says.

The surgeon makes a 2- to 3-centimeter incision in the area of the disc herniation and uses cameras to see inside the body as opposed to open discectomies.⁸ “The procedure removes just the part of the disc that’s pressing on the nerve, which means less disruption to the surrounding tissues,” says Ormond. An open discectomy uses larger cuts, and in order to see the disc that’s being operated on, the surgeon will need to move the muscles in your back to the side.

Microdiscectomy surgery has a 70 to 90 percent success rate when surgery is done within one year of symptoms starting. Waiting a year or more after symptoms begin decreases the success rate to about 80 percent.

Spinal fusion 

If your arthritis is severe and the removal of bone spurs may cause the spine to become unstable, you may need a spinal fusion. Spinal fusion surgery is more invasive and complex, with a longer recovery time. This is because fusions require more hardware to be inserted into the spine to create a firm, or rigid, fusion, whereas laminectomies and discectomies don’t require this hardware.  

During spinal fusion, the surgeon will take out the disc between the vertebrae and then fuse two vertebrae together using bone grafts — bone that’s been taken from elsewhere — or use metal hardware with screws. Having a spinal fusion means you have less movement or flexibility in this part of your spine. (Backbends are probably out of your future.)

Spinal fusion surgery for those with spondylolisthesis has a 70 percent success rate where patients report long-term improvement in their back or leg pain. 

Laminectomy

Laminectomy is a decompression-type surgery that treats spinal stenosis and eases the pressure on your sciatic nerve.^6, During the procedure, the surgeon removes some or all of the lamina, which is the vertebrae bone in the spine. A laminectomy will relieve the pressure on the spinal cord caused by the narrowing of the spine. 

A laminectomy can be done using open surgery with a 3- to 4-inch incision or using minimally invasive surgery (MIS) with smaller incisions and less bleeding and postoperative pain. Choosing minimally invasive surgery depends on factors such as how severe your surgeon thinks your condition is, your anatomy, and the expertise of the surgeon. 

“MIS is usually preferred because it allows for faster recovery and less tissue damage, but if there’s a need for more extensive work — like realigning the spine or working on multiple levels — open surgery may be the better choice,” says Ormond. “It really comes down to what’s safest and most effective for the patient.” 

The success rate of laminectomy surgery is 90 percent, with only 18 percent of patients needing another surgery within five years.¹²

Sciatica Surgery Procedure 

Whether you’ve been living with chronic pain or your sciatica has recently returned, the thought of surgery can seem daunting. Don’t hesitate to ask your medical team any questions or voice any concerns you have about your surgery. 

Some common questions you may ask your medical team before sciatica surgery include:

• Why is this surgery the best option?
• How experienced are you with this type of surgery? What is your success rate?
• What are the potential risks and complications associated with this surgery?
• How long will the surgery take, and what should I expect during the procedure?
• What type of anesthesia will be used, and how will it affect me?
• What is the expected recovery time, and what will the recovery process involve?
• Are there any presurgery preparations I need to make, such as lifestyle changes or stopping certain medications?
• What can I do to increase the chances of a successful surgery and recovery?
• How long will I need to stay in the hospital after surgery?
• What follow-up care or appointments will be necessary after surgery?
• What will happen if I choose not to have the surgery?
• Will my insurance cover the cost of the surgery and associated care? Are there any out-of-pocket expenses I should be aware of?

Here’s what you can expect when you have surgery for sciatica. 

Before surgery

To prepare for surgery, you may need to stop taking certain medications. If you take blood thinners, your physician will advise you to stop before surgery because of the risk of bleeding. You will also need to stop eating and drinking six to 12 hours before your surgery. 

Your surgeon will walk you through the surgery itself and what you can expect, which will vary depending on which surgery you have and why you’re having it done. You’ll also want to make sure you have someone to drive you home after your surgery. 

During surgery

Before surgery, a nurse will put in an IV in your arm to give you fluids and medications, including pain medications and antibiotics to protect against infection. These can be given in addition to general anesthesia, which is a medication that will put you to sleep during surgery. 

You’ll lie face down on the surgical table with a cutout of the table for your abdomen. This puts less pressure on the abdomen to prevent extra bleeding during surgery.¹² Your arms will be placed at a 90-degree angle to protect your shoulders and upper arms.^{8 12} 

The surgeon will make the incision and remove any damaged bone or tissue, relieving pressure on the nerve and decreasing symptoms. How large the incision is and the length of your surgery will depend on which type of surgery you receive for sciatica. Once surgery is completed, the surgeon will close up the incision, usually with sutures.⁸ 

After surgery

Recovery time

Sciatica surgery recovery time depends on several factors, including your age, general health, and the type of surgery. Discectomy usually provides the quickest recovery. Recovery can take longer if you’re getting bone spurs removed.  

“Oftentimes, the radiating leg pain improves almost immediately after surgery — even in the recovery room,” says Minnich. Since microdiscectomy uses small incisions and no hardware, postop pain is usually low.

Recovery from laminectomy can take longer, three to four months for your spine to heal and up to a year for a full recovery. You can expect to take off work for four to six weeks if you don’t have a physically active job. If you’re older and have a more complicated surgery, recovery may be up to four to six months. 

Post-operative recovery care

Immediately after surgery, you’ll need to avoid heavy lifting, bending, and twisting for a few weeks. But gentle walking is usually good for the healing process. Getting regular exercise after back surgery can help strengthen your back, according to the American Academy of Orthopaedic Surgeons. One 2019 study found walking a week after surgery was a predictor of “substantial improvement in function at six months.”

Your postop recovery will also include controlling your pain. Pain medications can help you recover and get you moving sooner.¹⁶ Types of medication for postop pain include:¹⁶

• NSAIDs, such as ibuprofen and naproxen, which decrease swelling and soreness and are given for mild to moderate pain
• Acetaminophen, given for mild to moderate pain, but won’t help with swelling
• Opioid medications, given for moderate to severe pain in the short term after surgery. These can be put in your IV immediately after surgery and as pills to be taken at home.

Physical therapy is an important part of the healing process because it can set you up to make a full recovery. 

“[Physical therapy] helps strengthen muscles, improve flexibility, and teach better movement habits. These things can prevent future injuries and speed up recovery. It’s not just about healing from surgery but also about building long-term resilience in the body,” explains Ormond. 

Physical therapy can begin two to six weeks following surgery. Your provider will recommend a quality physical therapist who can create a treatment plan to address your pain and help you recover from surgery. 

Therapy may continue for six to 12 weeks, depending on the type of surgery you received. Sometimes, you may wear a brace to help support your back, which is more common for spinal fusion. “In general, braces can be used temporarily after any spine surgery in order to provide support and stability to the muscles around the spine,” says Minnich. The length of time you’ll wear a brace may vary from three to eight weeks and up to four months, depending on your surgery. Minnich warns the brace shouldn’t be worn for too long because it can cause your core and back muscles to become weak and stiff.

Frequently Asked Questions (FAQs)

How do you know if you need surgery for sciatica?

You may need surgery for sciatica if other treatments you’ve done haven’t improved your symptoms. Sometimes, sciatica can be so severe that it causes leg and foot muscle weakness or loss of bowel and bladder control. Talk with your doctor if you think you may need surgery. 

How long are you in the hospital for sciatica surgery?

Microdiscectomy is done in a few hours in an outpatient surgical center where you go home the same day, as long as there are no complications. 

But a laminectomy or spinal fusion is more complex, and you may need to stay in a hospital. Laminectomies can last one to three hours. Most people can be discharged the same day, but some may stay in the hospital for a day or two.¹⁴ Spinal fusion therapy usually requires three to seven days in the hospital after surgery.  

What is the best surgery for sciatica?

The best surgery for your sciatica will depend on what is causing the sciatica. Microdiscectomy is the simplest and most common surgery done for sciatic pain that comes from herniated discs.  

How do you know if you need surgery for sciatica?

If other treatments such as physical therapy haven’t worked and your symptoms negatively impact your quality of life, or if you have muscle weakness in your legs or feet, then you may need surgery for sciatica. 

Finding the Right Sciatica Surgeon

Just as with any surgery, you’ll want to make sure the surgeon you choose has the right qualifications and experience to care for you. Neurosurgeons and orthopedic spine surgeons have specialized training in back, spine, and nerve conditions. Look for doctors who are board-certified in these specialties. 

Commons Clinic physicians provide all-inclusive services for orthopedic care, including costs upfront so there’s no surprises, starting with an initial consultation you can usually schedule the same day. Surgery, images, recovery therapies, and conservative treatments are all a part of Commons Clinic’s comprehensive treatment programs. 

Another factor to think about is sciatica surgery cost. Analysis shows the average cost of lumbar surgery is around $26,000. Ormond says that costs will vary based on your location, insurance, healthcare provider, and hospital, but here’s a breakdown on the estimates for types of spinal surgery:

• Microdiscectomy: $15,000–$50,000
• Laminectomy: $20,000–$70,000
• Spinal Fusion: $60,000–$150,000 

The cost will depend on your individual situation and type of surgery. Most insurances, including Medicare and Medicaid, cover the cost of surgery as long as there is a medical reason. Check with your individual insurance to see what your out-of-pocket costs will include. 

Conclusion

Sciatica can be a debilitating condition that significantly impacts one’s quality of life. While many cases resolve with conservative treatments, some individuals may require surgical intervention to find relief. The decision to undergo sciatica surgery should be made carefully, in consultation with experienced healthcare professionals who can guide patients through the various options and help them understand the potential risks and benefits.

For those considering sciatica surgery, it’s crucial to choose the right healthcare provider. Commons Clinic offers a comprehensive approach to orthopedic care, including sciatica treatment. Their all-inclusive services provide patients with upfront costs, eliminating surprises and allowing for better financial planning. With same-day initial consultations available, Commons Clinic makes it easier for patients to begin their journey towards relief promptly.

Ultimately, the road to recovery from sciatica is a personal one, often requiring a combination of treatments tailored to each individual’s needs. Whether through conservative measures or surgical intervention, the goal remains the same: to alleviate pain, improve function, and enhance overall quality of life. With the support of dedicated healthcare providers like those at Commons Clinic, patients can navigate their sciatica treatment with confidence, knowing they have access to a full spectrum of care options, from initial diagnosis through post-operative recovery and beyond.

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