Sciatica Surgery: Everything You Need to Know

Sciatica surgery is performed to alleviate sciatica, a type of pain that occurs when the sciatic nerve, which consists of several nerve roots that exit from the spinal cord to the low back, becomes compressed.

Increased pressure on the sciatic nerve causes pain in the low back, which can radiate and cause burning, tingling, and shooting pain in the buttocks, thigh, and lower leg. When sciatica symptoms cannot be relieved with noninvasive methods, surgery is considered to help manage the condition.

What is Sciatica Surgery?

The goal of sciatica surgery is to relieve the pressure being placed on the sciatic nerve from the nerve roots (where the nerve originates from) and the resulting nerve pain.

The sciatic nerve is the longest and thickest nerve in the body that comprises five nerve roots (L4, L5, S1, S2, and S3) from the lumbar spine of the low back and the sacrum (which sits at the bottom of the spinal column). It travels from the low back, down the hip and thigh, to below the knee, where it separates into two branches: the tibial nerve and common peroneal nerve.

Compression of one or more of the nerve roots comprising the sciatic nerve can be relieved through sciatica surgery.

Various Surgery Techniques

Different types of surgeries may be recommended depending on the cause of your sciatica:

• A discectomy is a procedure to remove a damaged disc between vertebrae of the spine. If a bulging or herniated disc is causing compression of the nerve roots, a small portion of the disc that is causing the compression will be removed to relieve the pressure from surrounding structures
• A laminectomy is a procedure to remove a portion of the vertebrae, especially if there is a bone spur (a bony outgrowth) due to arthritic and degenerative changes, to decrease compression of the nerve roots.
• A foraminotomy is a procedure to widen the foramina, the openings in the vertebrae where the nerve roots exit from the spinal cord, if they become narrowed. A surgical drill is used to enlarge the foramina to decrease pinching of the exiting nerve roots.
• A spinal fusion surgery is a procedure where two or more vertebrae are fused together with metal rods and screws. It may be required if an entire disc is causing severe nerve root compression and needs to be removed; if multiple laminectomies were performed, making the spine unstable; or if one vertebra has slipped forward over another, requiring stabilization

Potential Risks

Sciatica surgery is generally safe and effective, but some risks are associated with spinal surgery, including:

• Infection: Infection at the incision site may occur, but can be treated with antibiotics.
• Blood clots: Blood clots, especially in the leg, can form after surgery. The risk of these blood clots, also known as deep vein thrombosis, can be reduced by staying active during your recovery or wearing compression stockings to improve your circulation.
• Nerve damage: Nerve damage may occur during surgery, which can result in new numbness or weakness in one or both legs after the procedure. Paralysis is an uncommon but possible complication.
• Recurrence: Some sciatica symptoms may remain or come back a few years after the surgery. Nonsurgical treatments will usually be tried first to correct the issues, but additional surgery may be needed.

Purpose of Sciatica Surgery

Sciatica surgery is generally not recommended unless conservative treatments, including medications, cortisone injections, and physical therapy, fail to improve symptoms. Your healthcare provider may also suggest surgery if your pain is getting worse, if you have severe weakness in the muscles in your lower body, or if you have lost control of your bladder or bowel. Surgery is typically considered within one year of ongoing symptoms.

To diagnose and evaluate the severity of your sciatica, your healthcare provider will prescribe imaging tests, including x-rays, CT scans, and magnetic resonance imaging, which will help pinpoint where the issue is located.

Severe and unrelenting pain that is preventing you from standing or working would require more aggressive treatment and a shorter timeline to surgery. Loss of bladder or bowel control could require emergency surgery if it is caused by cauda equina syndrome.

How to Prepare

Your healthcare provider will schedule a surgical consult to discuss potential risks of undergoing sciatica surgery and review your health status, age, and medical history to determine if you are an appropriate candidate for the operation.

Location

Sciatica surgery is performed in a hospital operating room. You should expect to stay overnight for at least one night in the hospital. Your exact length of stay will depend on type of procedure you have. For a discectomy, laminectomy, or foraminotomy, you can expect to stay at the hospital for one to two days. Spinal fusion surgeries are more involved and typically require a longer stay of three to five days.

What to Wear

You will be asked to remove all clothing, undergarments, and jewelry and change into a hospital gown. Make sure to wear clothing that is easy to change out of, and leave valuables at home.

After your surgery, you may have some soreness and discomfort in your back, so it is best to come prepared with loose, comfortable clothing to change into after the operation. Cotton T-shirts and pants with an elastic or drawstring waistband are good options for easy dressing and undressing. They will also keep you comfortable while you are resting and recovering in your hospital room.

Food and Drink

Eating or drinking before sciatica surgery can cause problems during the procedure. As a general rule, you should stop eating and drinking between 8-12 hours before your scheduled procedure to minimize risks, including:

• All meals, large or small
• Snacks
• Candies, mints, and gum
• Beverages, including coffee and tea
• Alcohol
• Water

Eating a healthy diet and staying hydrated in the days and weeks leading up to your surgery will help minimize inflammation in your body and ease your recovery.

Medications

You may need to stop taking certain medications as far out as one week before your surgery to prevent excess bleeding or interaction with anesthesia during the operation. These medications include non-steroidal anti-inflammatory drugs and blood thinners. Always consult with your healthcare provider about all medications and supplements that you are taking.

Some medications may be taken the morning of your surgery. Be sure to do so with as little water as possible to minimize fluid in the stomach and the rest of the gastrointestinal system.

An anesthesiologist will talk with you and explain the effects of anesthesia and its risks before the surgery.

What to Bring

Items you will need for your surgery include:

• A form of identification, such as a driver’s license or passport
• Insurance documentation
• Loose, comfortable clothing to change into after the operation

To make your stay more relaxing and comfortable, you may want to bring:

• Your cell phone and charger
• Glasses or contact lenses
• Toiletries
• Headphones
• Books or magazines

Make sure to arrange for a friend or family member to provide transportation for you to and from the hospital since you will not be allowed to drive to or from the hospital before or after your surgery.

Pre-Op Lifestyle Changes

It is recommended that you stay active, eat a healthy diet, and quit smoking one to two weeks prior to the surgery to promote optimal healing and a smooth recovery. Minimizing stress and prioritizing good mental and emotional health are also important to lowering inflammation in the body to aid in your recovery.

What to Expect on the Day of Surgery

Sciatica surgery generally lasts one to two hours, except for spinal fusion surgery, which takes three to four hours. You may be asked to arrive 1-2 hours before your operation to fill out all required paperwork and undergo a physical exam.

Before the Surgery

On the day of the surgery, you will be taken to a pre-op room for a brief physical exam. A nurse will place an IV in your arm or hand for delivering fluids and medications like anesthesia. The surgical team will use the hospital bed to transport you in and out of the operating room.

You will be given anesthesia, which will put you to sleep so you won't feel anything during the surgery. Once sedated, you will be intubated with an endotracheal tube connected to a ventilator that will help you breathe during the procedure. You will also be rolled onto your stomach with your chest and sides supported by pillows. 

The surgical team will sterilize the skin around the area of your back where an incision will be made and cover your body with sterilized linens to keep the surgical site clean.

During the Surgery

For all procedures, the surgeon will make an incision vertically along the spine to access the problematic nerve roots that are causing your sciatica symptoms. Multiple surgeries may be performed at one time. In these cases, discectomies, laminectomies, and foraminotomies are completed first.

• Discectomy: An open discectomy or a minimally invasive discectomy may be performed. An open discectomy is performed by making an incision 1-2 inches in length for a single vertebral level. The muscles of the back are pulled to the side to expose the vertebrae of the spine. For a minimally invasive discectomy, a small incision less than 1 inch in length is made along one of the sides of the spine and a small tube is inserted into the space between adjacent vertebrae. This tube will be used to separate the back muscles and create a tunnel that will allow the surgeon to access the vertebrae of the spine and insert a camera, light, and surgical tools to remove the desired disc portion
• Laminectomy: An incision 1-2 inches in length will be made along the spine to access the affected vertebrae, and x-rays will be used to confirm the correct location. A bone drill will be used to first saw through and remove the spinous process (the bony projection on the back of each vertebra) and then the lamina of each affected vertebra. The ligamentum flavum, the thick ligament that connects one vertebra to another, will also be cut and removed at the level of the affected vertebral segments. Any excess bone growth or bone spurs will also be removed
• Foraminotomy: Like a minimally invasive discectomy, an inserted tube is used to separate the back muscles and allow access to the vertebrae of the spine. A surgical drill is used to shave away bone and enlarge the foramina to decrease pinching of the exiting spinal nerve roots.
• Spinal fusion surgery: A disc between adjacent vertebrae is completely removed and the vertebrae are fused together with metal rods and screws. A spinal fusion requires a bone graft to act as a spacer between the vertebrae where the disc was removed. If laminectomies were performed, the portion of bone removed from the vertebrae can be used as a spacer between the vertebrae. Alternatively, a small section of bone can be harvested from the top of the pelvis (called the iliac crest) through a small incision along the top of the hip. Metal rods and screws are drilled into the vertebrae to insert the bone graft and help hold the two vertebrae segments together

Once the procedures are completed, the surgeon with suture the incision together with stitches and place a bandage over the incision site.

After the Surgery

After the incision is closed, anesthesia will be stopped. The breathing tube will be removed as you slowly begin to wake up, and you will be transported to a recovery room where your heart rate, breathing, and blood pressure will be monitored.

You will spend several hours in the recovery room with access to medical staff 24 hours a day to address your needs after the operation. You can expect a visit from a physiatrist, a rehabilitation healthcare provider who will help manage your pain levels and symptoms after surgery.

A physical therapist will also visit you to assess how you are able to move after the operation, including getting in and out of bed and walking. They will also ask you questions about your living arrangements at home to make sure that you are able to be safely discharged. If you live alone and/or need significant help with everyday tasks, you may be sent to a subacute rehabilitation facility.

Recovery

The time it takes to recover can vary, from two to four weeks or less to resume a sedentary job to eight to 12 weeks for more physically demanding roles that require heavy lifting. For spinal fusion surgery, it will take at least four to six weeks before you can go back to work safely. Full recovery from spinal fusion surgery can take between six months to a year to resume normal activities.

During the first two weeks of recovery, you will have several restrictions in place to facilitate healing of the spine, including:

• No bending, lifting, or twisting
• No lifting anything that weighs more than 5 pounds
• No strenuous physical activity, including exercising, housework, yardwork, and sexual activity
• No driving or operating a vehicle of any kind until discussed with your surgeon
• No drinking alcohol in the initial stage of recovery or while taking narcotic pain medication

You should follow any other additional recommendations made by your surgeon.

You should sleep on your back and place pillows under your knees, or on your side and place a pillow between your knees, to maintain good spinal alignment. Avoid sleeping on your stomach since this position places increased strain on the low back, can cause more pain, and hinder your recovery.

If you are given a back brace, it should be worn at all times of the day except when lying down and sleeping. Your healthcare provider will advise you on when it is no longer be necessary.

Coping with Recovery

It is normal to have pain after sciatica surgery, and restrictions will be in place until your spine has healed enough and become adequately stabilized. You will be prescribed medication to control your pain after surgery. It is important to follow all instructions from your surgeon and physical therapist on medication and activity to promote optimal healing and recovery for the best possible outcome.

Follow the exercise program as prescribed by your physical therapist, and stay active and limit the amount of time you spend sitting each day. Also be sure to maintain proper posture with sitting, standing, walking, and sleeping to decrease strain on your low back.

Long-Term Care

Maintaining healthy habits can help with your recovery and prevent sciatica symptoms from recurring. These include:

• Getting at least seven to eight hours of uninterrupted sleep at night
• Eating a healthy diet of whole, natural foods including meats, poultry, fish, fruits, vegetables, nuts, and starches while limiting processed foods, sugar, refined grains like wheat and corn, and artificial sweeteners, flavors, colors, and food additives
• Managing a healthy weight and lean body mass through regular exercise
• Staying adequately hydrated
• Learning proper lifting techniques to utilize your core and leg muscles to prevent increased pressure on your spine

Possible Future Surgeries

Your surgeon may not know the full extent of surgical work that needs to be performed until the operation is started. Always confirm with your healthcare provider about what procedure you will be undergoing and ask about the possibility of whether you may need additional surgeries.

Multiple procedures may need to be performed at once to create enough space in the openings of the spine. In the case that multiple laminectomies were performed, spinal fusion surgery may need to be performed to stabilize the spine. If a less invasive procedure like a discectomy was initially performed and symptoms do not improve, spinal fusion surgery may be considered to remove the problematic disc entirely.