Back pain and sciatica: when should you see a spinal surgeon for treatment options?

Back pain is one of the most common reasons people visit their GP, and sciatica is often a concerning symptom. Most cases improve with time and conservative management, but some situations require specialist input.

In this article, consultant orthopaedic spinal surgeon Mr Ghulam Abbas explains what back pain and sciatica are, when to consider seeing a spinal surgeon, and the treatment options available.

What is back pain?

Back pain can be caused by muscle strain, ligament injuries, poor posture, or degenerative spine conditions. It may be acute, lasting a few days or weeks, or chronic, persisting for months. While uncomfortable, most back pain is not serious and improves with rest, gentle exercise, and physiotherapy.

What is sciatica?

Sciatica occurs when the sciatic nerve, which runs from the lower back down the leg, is irritated or compressed. Symptoms include sharp, shooting pain, tingling, numbness, or weakness in the leg. Common causes include herniated discs, spinal stenosis, and other degenerative spine conditions. Persistent sciatica can significantly affect mobility and quality of life.

When to seek specialist advice

Immediate referral to a spinal surgeon is necessary if you experience:

• Loss of bladder or bowel control.
• Progressive leg weakness.
• Severe numbness around the groin or buttocks (saddle area).
• Unexplained weight loss, fever, or history of cancer.

These may indicate serious conditions such as cauda equina syndrome, spinal infection, or spinal tumours, which require urgent attention.

Persistent pain despite conservative treatment

If back pain or sciatica persists for more than 6–12 weeks despite physiotherapy, pain relief, and lifestyle measures, a spinal surgeon can assess whether further investigation or intervention is appropriate. This usually involves imaging, such as MRI, to identify structural issues in the spine.

Treatment options offered by spinal surgeons

Spinal surgeons often recommend continuing conservative management initially. This may include:

• Physiotherapy and targeted exercises.
• Pain medications and anti-inflammatories.
• Epidural steroid injections for severe nerve inflammation.

These approaches aim to relieve symptoms without surgery.

Surgical treatments

Surgery is considered when symptoms are severe, persistent, or associated with nerve compression. Common procedures include:

• Microdiscectomy: removal of part of a herniated disc to relieve nerve pressure.
• Laminectomy: widening the spinal canal to reduce nerve compression.
• Spinal fusion: stabilising the spine in cases of spinal instability or severe degeneration.

Surgery is carefully tailored to each patient after thorough assessment, balancing benefits and risks.

Not all back pain or sciatica requires surgery. Many patients achieve excellent relief with non-surgical treatment. Spinal surgeons provide personalised advice, focusing on improving function, reducing pain, and preventing recurrence.