When to Consider Surgery for Herniated Discs and Sciatica Pain

Herniated disc

Last Sunday (July 29), I woke up in the middle of the night with severe sciatic pain radiating down to my leg, making it difficult to walk, sit, or lie down.
That day, I went to the emergency room at National Taiwan University Hospital, but they only administered pain relief injections.
On Tuesday, I visited the emergency department at Veterans General Hospital for a CT scan, and the doctor said I would have to wait for an outpatient appointment to get the results.
Earlier in July, I had an MRI at Chang Gung Memorial Hospital, where the doctor indicated that there was evidence of a herniated disc in my lumbar spine, but suggested monitoring it for a month to see if it improves before deciding on the next steps.

I would like to know if a herniated disc compressing the sciatic nerve can lead to symptoms such as weakness in the buttocks, inability to stand straight, pain after prolonged sitting, and difficulty lying flat.
Under what circumstances or severity should surgery be considered? I have heard that if acute pain symptoms subside, rehabilitation, electrical therapy, and traction can be used to treat sciatica, so I would like to understand what conditions or severity would necessitate surgery.
Thank you.

Zhu, 20~29 year old female. Ask Date: 2001/08/07

Dr. Shao Guoning reply Neurosurgery

Hello Mr.
Zhu,
You are a typical case of sciatic nerve pain that requires treatment.
A computed tomography (CT) scan or magnetic resonance imaging (MRI) can reveal the extent of nerve compression.
If it is due to a herniated disc, surgery is the only definitive solution.
Currently, microsurgery or endoscopic surgery can precisely remove the lesion through a minimally invasive incision, allowing you to get out of bed on the same day of the surgery, with no associated risks.
Wishing you health and happiness.

Reply Date: 2001/08/07

More Info

When considering surgery for herniated discs and sciatica pain, it is essential to evaluate several factors, including the severity of symptoms, the duration of pain, and the impact on daily life. Herniated discs can cause significant discomfort, particularly when they compress nearby nerves, leading to conditions like sciatica, which is characterized by pain radiating down the leg, often accompanied by weakness or numbness.

In your case, where you have experienced acute pain that radiates to your leg, difficulty walking, and an inability to sit or lie down comfortably, these symptoms suggest that the herniated disc may be significantly affecting your quality of life. The decision to proceed with surgery typically hinges on the following criteria:
1. Duration of Symptoms: If you have been experiencing severe symptoms for more than six weeks without improvement, surgery may be considered. This timeframe allows for conservative treatments, such as physical therapy, medications, and possibly injections, to take effect.

2. Severity of Symptoms: If the pain is debilitating and significantly limits your ability to perform daily activities, this is a strong indicator for surgical intervention. Symptoms such as severe weakness in the legs, loss of bowel or bladder control, or progressive neurological deficits warrant immediate surgical evaluation.

3. Response to Conservative Treatment: If you have tried conservative treatments, including physical therapy, pain medications, and possibly epidural steroid injections, without relief, surgery may be the next step. It is crucial to document the effectiveness of these treatments over time.

4. Imaging Results: MRI or CT scans that confirm a herniated disc compressing a nerve root can support the decision for surgery, especially if there is evidence of nerve damage or significant compression.

5. Quality of Life: If your pain is affecting your mental health, sleep, and overall well-being, and you find yourself relying heavily on pain medications, it may be time to discuss surgical options with your healthcare provider.

In your situation, since you have already undergone imaging and have been advised to wait for a month to see if symptoms improve, it is essential to follow up with your healthcare provider after this period. If your symptoms persist or worsen, a discussion about surgical options should be initiated.

Surgical options for herniated discs typically include discectomy, where the portion of the disc that is pressing on the nerve is removed, or more extensive procedures like spinal fusion if there is instability. The goal of surgery is to relieve pressure on the nerve, alleviate pain, and restore function.

It is also important to consider the potential risks and benefits of surgery. While many patients experience significant relief post-surgery, there are risks involved, including infection, bleeding, or the possibility that symptoms may not improve.

In summary, surgery for herniated discs and sciatica pain should be considered when conservative treatments fail, symptoms are severe and persistent, and when the quality of life is significantly impacted. Always consult with a spine specialist to discuss your specific case and explore all available options.

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