Sciatica causes low back pain along with its trademark symptom: a sharp pain that suddenly shoots down one leg. An estimated 40% of adults experience at least one bout of sciatica. For many, one episode turns into a chronic and often debilitating problem.
Treatment for sciatica always begins with conservative therapies such as medication and physical therapy. Richard B. Kim, MD, also specializes in specializes in minimally invasive options to relieve sciatic pain.
When you still have symptoms despite conservative treatments, it’s time to learn if spinal surgery to repair the root cause of your sciatica can ease your symptoms. In this blog, we explain the most common surgical options for sciatica.
The excruciating pain of sciatica occurs when the sciatic nerve becomes pinched (compressed) by structures in your spine. Though nerve compression may occur following an injury or because of a spinal tumor, natural age-related degeneration is the top cause.
The conditions responsible for sciatica include:
During your first appointment, we identify the underlying cause of your sciatica because that determines the surgery that’s best for you.
Though we use many surgical techniques, they all have one goal: to decompress the sciatic nerve.
The most common procedures for treating sciatica include:
A discectomy treats a herniated disc or degenerative disc disease. Whenever possible, we use minimally invasive techniques, and when we do, the procedure is called a microdiscectomy.
During a discectomy, we remove either the damaged portion of the disc or the entire disc. We also take care of other problems that may contribute to your sciatica, such as bone spurs and thickened ligaments.
Eliminating the damaged, protruding part of the disc that’s pushing against the nerve leaves the remaining healthy disc in place to support the spine. If we need to remove the entire disc, we restore spinal stability by replacing it with an artificial disc or fusing the adjacent discs together.
The back side of each vertebra is called the lamina. During a laminectomy, we take out the entire lamina. In some cases, we only need to remove part of the lamina. Then the procedure is called a laminotomy.
Removing the bone creates more space for the nerve, eliminating pressure and easing your symptoms. We may need to remove thickened ligaments or other structures pushing against the nerve. The bone loss doesn’t always cause spinal instability, but if it does, we perform a spinal fusion.
As the sciatic nerve leaves your spine to go down your legs, it passes through the foramen, an opening between two adjacent vertebrae. Spinal problems like bone spurs, bulging or herniated discs, enlarged ligaments, or a slipped vertebra (spondylolisthesis), can protrude into the foramen and compress the nerve.
If your sciatica arises from problems in the foramen, we perform a foraminotomy to deal with the protruding structure and enlarge the opening. In some cases, we may also do a laminectomy to achieve greater nerve decompression.
You need a facetectomy when the nerve compression occurs in the facet joints connecting two adjacent vertebrae. Problems affecting the facet joints include degenerative disease (arthritis), tumors, vascular disease, and inflammatory conditions that damage the bone.
Nerve compression occurs as these conditions weaken the joint. We may need to remove part or all of the joint, depending on the extent of the damage. Sometimes we also need to perform a foraminotomy, laminectomy, or laminotomy at the same time as a facetectomy.
If you struggle with lower back and shooting leg pain and would like to learn more about your surgery options, call Richard B. Kim, MD, or request an appointment online today.