Lumbar disc surgery for sciatica: What you need to know

If you are living with persistent leg pain caused by sciatica, you may be wondering whether surgery is the right option.

In this article, consultant neurosurgeon Mr Justin Nissen explains what lumbar disc surgery involves, when it may be recommended, and what you can expect from recovery.

What is sciatica and how is it linked to the lumbar spine?

Sciatica refers to pain that radiates along the sciatic nerve, often starting from the lower back and radiating down the leg. It does not need to involve the whole leg and could be limited to the calf or buttock.

It is often caused by compression or irritation of one of the spinal nerve roots in the lumbar (lower back) region.

The most frequent underlying cause is a lumbar disc herniation (slipped disc), where part of the disc bulges out and compresses a nearby nerve root.

This can cause symptoms like:

Shooting or burning leg pain.
Numbness or tingling.
Muscle weakness in the affected leg.

If it causes any disturbance of bladder or bowel function, changes in sensation, or numbness around the genital area, you should seek urgent medical attention.

When should lumbar disc surgery be considered?

In the majority of cases, sciatica improves with non-surgical treatments, including physiotherapy, pain medication, activity modification and gentle exercise. Many patients are likely to improve with a low-risk spinal injection and most patients see improvement within a few weeks to a few months.

Surgery may be considered if:

Pain persists beyond 6 to 12 weeks despite appropriate conservative management.
The pain is severe and disabling.
There is significant or progressive leg weakness.
There are signs of nerve damage (foot drop).
There is loss of bowel or bladder control (in which case emergency surgery may be required).

What does lumbar disc surgery involve?

The most common surgical treatment for sciatica caused by a herniated disc is a microdiscectomy.

A small incision (2 to 4 centimetres) is made in the lower back, directly over the affected area of the spine. Using either an operating microscope or surgical loupes (magnifying lenses), the surgeon carefully removes the portion of the disc that is pressing on the nerve. In some cases, a small amount of bone or ligament may also be removed to access the area safely.

The procedure is typically performed under general anaesthetic and takes around 1 to 2 hours.

What to expect after surgery

Most patients go home on the same day or after one night in hospital. Recovery times vary, but many return to light activities within 2 weeks and resume more physical tasks within 4 to 6 weeks.

A structured physiotherapy plan is usually recommended post-operatively to support recovery and reduce the risk of recurrence.

What are the benefits and risks?

Benefits include rapid and significant relief from leg pain, low risk of recurrence, improved mobility and overall quality of life.

All surgical procedures carry some risk. With lumbar disc surgery, these may include:

Infection
Bleeding
Dural tear (a small leak of spinal fluid, sometimes repaired during surgery).
Nerve injury (weak foot, persistent pain).
Recurrent disc herniation
Incontinence

Your surgeon will discuss these risks with you in detail prior to any procedure.

For patients with persistent or severe sciatica, lumbar disc surgery can be a highly effective solution.

If your symptoms are ongoing despite non-operative treatment, consult with Mr Nissen via his Top Doctors profile.