First a huge and important disclaimer. I am not in any way medically qualified, and do not pretend to be. Everything I say is from a viewpoint of a person with 10 years-worth of sciatica suffering. I have tried to write accurately but I cannot guarantee I have got everything right. I’m very happy for physiotherapists, or other clinicians, to put me right on anything!
Common back surgery for sciatica
Surgery to relieve sciatica is usually considered only after an extended period of non-surgical (conservative) treatment has not proved successful enough.
Depending on the cause and duration of the sciatic pain, one of two general surgeries will typically be considered:
- a microdiscectomy (or discectomy)
- a lumbar laminectomy.
The main idea behind surgery is to relieve the nerve root irritation or compression.
During a discectomy the surgeon will remove the portion of the disc that is herniated and pressing on the nerve root.
During a laminectomy the surgeon will create space for the nerve root by removing the lamina, which is the back part of the vertebra that covers the spinal canal. The diagram below shows the invertebral foramen which is basically the hole that the nerve root passes through, and the lamina that sits just behind it. Removing part of the lamina provides a larger hole for the nerve root to pass through, so helping to reduce any compression occurring on the nerve root.
There is good evidence that discectomy is effective in the short term. but, in the long term that it is no more effective than prolonged conservative treatment.
I underwent combined discectomy and laminectomy surgery 18 months after my accident which relieved the pressure on my S1 nerve, however it appears that my nerve had been permanently damaged by then and I have been left with residual symptoms. I know of people who have had much better responses to surgery.
So there we have it, this is my simple understanding of what causes sciatica, radicular pain and radiculopathy.