Sciatica and Disc Herniation: When to Consider Surgery

Q: Sciatica and Disc Herniation: When to Consider Surgery

Hello： The symptoms you described do seem to indicate spinal stenosis. <br>An MRI should clearly reveal the areas of narrowing. <br>If the symptoms are severe and affecting your daily life, surgery is the best solution. <br>Best wishes, Dr. <br>Yu-Shu Chiu.

Lower back pain

Hello Doctor: After a car accident at the age of 18, I have experienced persistent lower back pain, numbness in the sole of my right foot, and difficulty standing or sitting for long periods, as well as walking for extended durations.
Walking for a while causes a slight limp, and when I sit down, I experience cramping sensations, feeling as though the nerves in my right leg are being pulled.
After more than a year of treatment, my condition improved, and I no longer experienced the aforementioned symptoms, so I stopped physical therapy.
However, starting last year, I have been unable to stand for long periods again, and when the weather turns cooler, I experience numbness in my right foot.
I have also noticed that after walking for a while, I still experience symptoms similar to before, including temporary limping.
Resting by sitting down alleviates the symptoms, but I still feel the pulling sensation in the nerves of my right leg.
Sometimes, upon waking, I feel lower back pain and numbness in the sole of my right foot, and occasionally, I experience pain and weakness in my right big toe.
These symptoms can last for several days; after a few days, the lower back pain subsides, but I then experience soreness on the inner side of my right calf and numbness in the sole of my right foot.
The areas where I feel soreness and numbness vary.
Therefore, I underwent an MRI in August to September last year, and the doctor informed me that I have a herniated disc with nerve root compression at two locations, one between L1 and L5, and another in the lumbar region with stenosis.
He suggested that since physical therapy was ineffective, surgery might be necessary, indicating a serious condition.
Later, I was referred to a neurosurgeon, who, in addition to what the first doctor mentioned, found another area of compression and diagnosed me with sciatica.
The first doctor recommended that I undergo more detailed examinations at a medical center.
Consequently, I went to Taichung Veterans General Hospital for a consultation.
However, after undergoing nerve conduction studies, it was indicated that there was no nerve dysfunction.
The doctor seemed to think my condition was not serious, yet the MRI clearly showed nerve compression.
Can an MRI fail to demonstrate nerve dysfunction? What exactly is going on in my case? Is this considered a second recurrence? Recently, I have frequently experienced numbness in my right foot.
Should I consider surgery? What type of surgery carries less risk? Which doctor should I consult for the surgery?

Yiting, 20~29 year old female. Ask Date: 2006/05/17

Dr. Qiu Yushu reply Neurosurgery

Hello: The symptoms you described do seem to indicate spinal stenosis.
An MRI should clearly reveal the areas of narrowing.
If the symptoms are severe and affecting your daily life, surgery is the best solution.
Best wishes, Dr.
Yu-Shu Chiu.

Reply Date: 2006/05/17

More Info

Sciatica and disc herniation are common conditions that can significantly impact a person's quality of life. Understanding when to consider surgery for these conditions is crucial, especially for someone like you who has been experiencing symptoms for an extended period.

Understanding Sciatica and Disc Herniation
Sciatica refers to pain that radiates along the path of the sciatic nerve, which branches from your lower back through your hips and buttocks and down each leg. Typically, sciatica affects only one side of your body. The pain can vary widely, from a mild ache to a sharp, burning sensation, and it may also cause numbness, tingling, or muscle weakness in the affected leg.

Disc herniation occurs when the soft material inside a spinal disc pushes out through a tear in the tougher exterior. This can lead to nerve compression, resulting in pain, numbness, or weakness in the legs. In your case, the MRI findings indicate that you have disc herniation at multiple levels (L1-L5) with nerve root compression, which is likely contributing to your symptoms.

When to Consider Surgery
Surgery for sciatica and disc herniation is generally considered when:
1. Conservative Treatments Fail: If you have tried physical therapy, medications (like NSAIDs or muscle relaxants), and other non-surgical treatments for an extended period (usually 6-12 weeks) without significant improvement, surgery may be warranted.

2. Severe Symptoms: If you experience severe pain that significantly affects your daily activities, or if you have symptoms like weakness in the leg, loss of bladder or bowel control, or progressive neurological deficits, surgery may be necessary.

3. Quality of Life: If your symptoms are affecting your quality of life, such as preventing you from working or engaging in daily activities, it may be time to consider surgical options.

Types of Surgery
The most common surgical procedures for disc herniation include:
- Microdiscectomy: This minimally invasive procedure involves removing the herniated portion of the disc that is pressing on the nerve. It typically has a shorter recovery time and less postoperative pain compared to traditional open surgery.

- Laminectomy: This involves removing a portion of the vertebra (the lamina) to relieve pressure on the spinal cord or nerves. It may be recommended if there is significant spinal stenosis (narrowing of the spinal canal).

- Spinal Fusion: In cases where there is instability in the spine, a fusion may be performed to stabilize the affected vertebrae.

Risks and Considerations
Every surgical procedure carries risks, including infection, bleeding, nerve damage, and complications related to anesthesia. The risks can vary depending on the type of surgery and your overall health. Microdiscectomy generally has a lower risk profile compared to more invasive procedures like spinal fusion.

Next Steps
Given your symptoms and MRI findings, it’s essential to have a thorough discussion with a spine specialist or neurosurgeon. They can evaluate your specific case, consider your medical history, and help you weigh the benefits and risks of surgery versus continued conservative management.
Additionally, if you are experiencing new or worsening symptoms, such as increased numbness or weakness, it’s crucial to seek medical attention promptly.
In conclusion, while surgery can be a viable option for managing sciatica and disc herniation, it should be considered carefully and in consultation with a qualified healthcare professional. Your ongoing symptoms and the impact on your daily life are significant factors in this decision-making process.

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