One percent of the population suffers from sciatica at any one point in time. Sciatica is pain down a person’s leg that is electrical and burning in nature and can be quite severe. It results from a disc herniation pushing on the nerve root, and the resulting inflammation causes the pain traveling down the person’s leg through the area where that nerve root provides sensation.
Fortunately, most patients who experience severe sciatica do not need surgery to relieve the pain. When should surgery be undertaken? Here are the considerations for when an operation should be performed.
There’s only one true instance where surgery for a herniated disc is absolutely mandatory. If the disc herniation results in a condition called cauda equina syndrome, an individual will end up with bowel or bladder dysfunction along with significant pain and disability.
When cauda equina occurs, it is a true surgical emergency and should be addressed within 24 hours.
Cauda equina syndrome is rare, and a more common scenario is compression of the nerve root leading to motor weakness. This may show up as a foot drop, or quadriceps
weakness. It also may involve weakness of everting the foot, or other motor functions. It really depends on which nerve root is being pinched.
When motor weakness presents itself, it does not mean the patient has to undergo surgery. It should be watched very closely, and if it becomes progressive then surgery should be heavily considered. If it is not progressive, it can be watched for a month or two to see if function improves. So motor weakness is what is called a relative indication for surgery, not an absolute.
The additional indication for surgery is simply for intolerable pain. If an individual undergoes considerable conservative treatment for over six weeks, and the pain is not tolerable at that point, surgery can be considered. Epidural steroid injections for sciatica work well over 75% of the time. A series of injections may be necessary for best results. Along with the injections, pain management medication may be necessary along with PT, chiropractic, acupuncture and more. Over 95% of the time, satisfactory pain relief can be achieved so that surgery can be avoided.
A landmark study in the Journal of the American Medical Association showed that surgery for a pinched nerve allows patients to get back to work faster and to get rid of their pain quicker. Interestingly, at the one year point after surgery, the results were overall no different than if the individual had continued conservative treatment.
While a lumbar discectomy surgery is typically highly successful and maintains low risks, those risks cannot be ignored. There is a risk of infection, nerve injury, anesthesia complication, bleeding and failure to relieve the pain. Regardless of whether surgery is performed, the risk of a re-herniation at the same level is 10%.
If you or a loved one lives in the greater Phoenix and Scottsdale metropolitan area and is suffering from sciatica, let the best Arizona pain clinics in the valley help you. Arizona Pain Specialists has an award-winning team of double Board Certified pain management doctors along with exceptional Phoenix chiropractors.
The practice has multiple locations and offers pain management Mesa AZ, Glendale AZ, surprise, Tempe and Phoenix/Scottsdale trust. Call 602 507 6550 for one number scheduling today!