Sciatica and its relationship to excess weight

Written by: Mr Will Kieffer
Edited by: Karolyn Judge

Clinical research has found that people with excess weight are more likely to have sciatica. Leading consultant orthopaedic spinal surgeon Mr Will Kieffer speaks to Top Doctors about the two conditions' relation to one another, alongside how sciatica can get better on its own in people of all body sizes. 


He considers other topics such as sciatica management, and what's involved in sciatica surgery, in this informative article. 


Close up of black woman with sciatic leg pain


What is the relationship between obesity and sciatica?

There's a relatively strong relationship between obesity and sciatica. It's difficult to prove a causative effect and certainly being less active can be a causing factor of sciatica


There's a big piece of research that was done, that looked at obesity and sciatica, and leg pain as a result of nerve pressure, and it was very strongly linked. Actually it was linked to; the more overweight you are, the more likely you are to suffer from sciatica



How is sciatica managed in patients who are overweight or obese?

The good news about managing sciatica regardless of your body size is that the majority of patients will get better on their own. And that's statistically probably about 70 to 80 per cent over the first six weeks or so, so sciatica is often a self-limiting condition


The challenge comes in when that sciatica doesn't settle on it's own, or if it's associated with some rarer symptoms such as weakness in leg or in the foot, or loss of sensation. Or indeed, problems with the bladder or bowel, which are surgical emergencies. And in that case, then, escalating treatment through injection treatments to try and calm down the inflammation around the disc if that's the cause of the sciatica, or indeed surgery to relieve pressure on the nerves, to relieve the neurological damage that's happening. There can then be the other options moving forward.  



When is surgery recommended?

Surgery's generally recommended as an emergency for patients who have pressure on the nerves that supply their bladder and bowel. That's a condition called cauda equina syndrome. The other recommend surgical treatment is if someone's developed weakness that's progressive, or loss of function in their limb that's progressive. That's usually associated with a disc, and when there's more tightness around the nerves which is called spinal stenosis, then that's when all other treatments have failed and the patient's quality of life is suffering. That's the stage where surgery would generally be recommended.


How is sciatica surgery performed?

The treatments for sciatica surgeries are dependent on the cause of the leg pain. If that's due to a restriction of pressure on the nerves, for example, with tightness due to arthritis of the back of the spine, then the procedure is to relieve the pressure on those nerves by performing a decompression. This is to move, or take away, the arthritis and to free the nerves and the sac of nerves up. 


If it's disc herniation then the pressure comes from underneath from where the disc is, so again the procedure is usually from the back, which then involves moving down to get to that disc. So, moving the nerves out of the way to remove that disc herniation or disc prolapse, slipped disc that's come out and to free up the nerves in that respect. 


There are different types of sciatic procedure, therefore more or less relatively involved if it was a discectomy surgery, which is the removal of a prolapse or slipped disc, then that can be done as a day case procedure with a relatively short stay in hospital for one night. If it's a more wider-spread surgery, for example, to remove pressure on multiple areas of the spine, then that often takes a night or two in hospital.    



Is surgery a definitive treatment for sciatica? Or is further treatment required following surgery?

Surgery is often the definitive treatment. However, there's always a risk of recurrence with sciatica. If it's a disc herniation then there's risk of it coming back and interestingly, that's actually higher with surgery. That's because there's been surgical damage to the disc, whereas without surgery, your risk of a recurrent episode of sciatica is probably about five per cent over 10 years. So, one in twenty, which is pretty good statistics.


With stenosis, which is related to arthritis in the lumbar spine in the lower back, then that arthritis obviously hasn't been removed and it can progress, and therefore can regrow. The odds of that are probably about one in three over ten years, or slightly less.  



If you're looking for expert sciatica surgery, or require other orthopaedic treatment, visit Mr Kieffer's Top Doctors profile to arrange a consultation.

By Mr Will Kieffer
Orthopaedic surgery

Mr Will Kieffer is a consultant orthopaedic spinal surgeon based in Surrey and Sussex. He specialises in back pain, back and neck surgery and spinal surgery alongside pain management, minimally-invasive surgery and sciatica. He privately practices at Spire Gatwick Park Hospital and Nuffield Health Haywards Heath Hospital as well as for the NHS at East Surrey Hospital, where he is clinical lead alongside his esteemed consultant role.  

Furthermore, Mr Kieffer has a special interest in spinal fusion and spinal disc replacement and offers treatment in various spinal procedures such as cervical discectomy and fusion, and spinal fractures including rehabilitation and fragility fracture treatment (kyphoplasty/vertebroplasty), among many others.

Mr Kieffer works towards providing the most suitable treatment for his patients in the knowledge that spinal surgery is a significant undertaking, reserved for those who truly require it. He is also trained in non-operative measures including injection therapy for the cervical, thoracic and lumbar as well as sacroiliac and coccygeal joints and areas.

Mr Kieffer is educated and trained to a high standard. He graduated with an MBBS in Medicine and BSc in Medical Physics and Bioengineering from University College London and underwent his higher surgical training in the Kent, Surrey and Sussex region. 

He completed his first spinal fellowship at Frimley Park Hospital in Surrey and the next at Auckland City Hospital in New Zealand, where he treated top sportspeople. His experience in sports medicine also saw him work as the team doctor for an English Football League Championship side and provided medical advice for a television drama series. 

Mr Kieffer is dedicated to research as Orthopaedic Lead for National Research Projects in trauma and orthopaedics at East Surrey Hospital, and his main interests are degenerative spinal disorders (clinical), spinal balance and adult deformity (research). His work studying these areas have been awarded, published in peer-reviewed journals and in book chapters, too. 

He is also dedicated to passing on his medical knowledge, sitting on the NHS Speciality Training Committee and Annual Review Panels for the Kent, Surrey and Sussex regions. They are responsible for training NHS orthopaedic surgeons in the areas. Mr Kieffer regularly teaches and is an Advanced Trauma Life Support instructor for the Royal College of Surgeons and a course tutor for the Fellowship of the Royal College of Surgeons (Tr and Orth). 
Mr Kieffer is an active member of several medical organisations including the British Association of Spinal Surgeons (BASS), the British Orthopaedic Association (BOA) and the North American Spine Society (NASS) alongside the General Medical Council (GMC) and British Medical Association (BMA). He is also a fellow of the Royal College of Surgeons of England. 

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