30.JUN.2020 5 MIN READ | 5 MIN READ

Sciatica can have a severe impact on daily life. If non-surgical options have proven to be ineffective, it may be time to consider surgery.

Sciatica is a condition caused when the nerves in your spine get compressed or ‘pinched’ in your spine. This is medically referred to as a compressed sciatic nerve.

Sciatica can cause inflammation, pain and sometimes numbness that radiates down from the lower back, through the hips and buttocks, and into the legs. This can have a severe impact on your life, making it difficult to move around or even perform daily tasks.

Increased pressure on the nerve from additional weight, including pregnancy, is a contributing factor to sciatica, as well as health conditions such as diabetes. In addition, work or daily situations that require a lot of heavy lifting or long hours of sitting can also be a cause.

By some accounts, lower back pain is the second most common complaint seen by general practitioners. In recent months, the experience of working from home without the benefit of proper desks and seating can aggravate this condition.

The level of pain caused by sciatica can vary from person to person, and many respond well to non-surgical treatments. However, some may find that these options are not satisfactory. Furthermore, symptoms like severe pain, weakness in the leg or being unable to control bladder or bowel movement may indicate a condition that has worsened from nerve inflammation to nerve damage. At this point, leaving it untreated may result in permanent repercussions.

Treatment Options

Non-surgical treatments

Steroid injection
Pain management can range from simple home remedies such as cold or hot packs and over-the-counter pain medication, to prescription medications or steroid injections to reduce the inflammation. Long-term management of sciatica may also include physical therapy. For some, this treatment may prove to be most effective.

Surgery

If and when non-surgical options are unsuccessful in managing severe pain, surgery may be considered. Surgery for sciatica is performed with the objective of removing the source of pressure. This is usually a bone growth or spur, slipped disc (sometimes known as a herniated disc), misaligned vertebra, or a growth in the spine such as a cyst or tumour.

Surgery for sciatica may involve one or more of these procedures, which are performed under general anaesthesia:

Microdiscectomy

This minimally invasive procedure can help patients with a herniated lumbar disc, one of the most common reasons for compressed spinal nerves.

A small incision is made, allowing the surgeon to remove the slipped disc that is pressing on the nerve. After the incision is closed with sutures, the patient may be discharged within the same day or after overnight observation.

Most patients can expect full recovery in approximately 6 weeks; during this time, they will need to avoid sitting up for prolonged periods, and should not bend over or lift heavy items.

Laminectomy

Laminectomy
This removes part of the overgrown vertebral bone that may be compressing the nerves, providing more room in the spinal canal. It may also be a necessary procedure for surgeons if they need access to a damaged disc. A small incision is made to allow the surgeon to access the affected vertebrae and remove the overgrowth.

Post-surgery, a short hospital stay may be necessary and patients should avoid driving for at least two weeks, because of the movements and posture it involves. Similarly, you should avoid sitting for long hours, bending, and lifting of items.

Foraminotomy

This is done to remove bony growths and enlarge the neuroforamen, the spaces on each side of the backbone, to allow more room for the nerve root to exit the spinal column. The incision is made over the spinal column, allowing the surgeon to cut or shave away the affected bone and remove any bone fragments.

Most patients are able to sit up and get out of bed within a few hours and leave the hospital within 24 hours. They should avoid driving for at least two weeks and resume light work after four weeks or more.

Facetectomy

In this procedure, facet joints are trimmed or removed to relieve nerve pressure. The duration will depend on the angle and extent of surgical intervention required.

After surgery, the doctor may require patients to begin walking for short distances. They may be required to stay overnight or longer, and post-surgical pain or discomfort may last several weeks. During this time, part of the recovery process is to continue walking independently, increasing the distance over time until they are able to walk as normal.

What patients need to know

Bear in mind that, while surgery for sciatica can result in great improvement in terms of pain relief and movement, there may still be lingering pain and a chance that the compressed nerve may recur at a different vertebra along the spine.

Any form of surgery comes with risks and general anaesthesia is required. To get a clear understanding, it’s important that patients speak to their doctor about the available treatments options, and what to expect during and after surgery. This enables them to make well-informed decisions.

Patients and their caregivers will also need to learn how to care for the wound. Medication may also be prescribed for post-operative pain, with follow-ups necessary for the removal of stitches and to monitor recovery. It’s important to remember that recovery time varies, from a few weeks to a few months. This would be based on the extent of the surgery and severity of the condition. A patient’s pre-existing medical conditions such as high blood pressure or diabetes, and lifestyle factors, such as smoking, can influence recovery.

Generally, minimally-invasive procedures offer shorter recovery times when compared to open surgery. Physical therapy may also be recommended as part of rehabilitation to improve a patient’s strength and flexibility, and to help prevent back pain from recurring. Follow any pre- and post-surgery instructions carefully as these recommendations would be tailored to each patient’s condition and recovery.

Considerations before surgery

Before surgery
It’s important to speak to the doctor managing the patient’s condition, as they would be most familiar with the patient’s medical history, including any non-surgical treatment options which have been tried. Discuss these options thoroughly and ask for a recommendation or referral to an orthopaedic surgeon. Ensure your medical records are made available prior to the appointment with the specialist.

In the meantime, should any sudden, unusual or intense pain be experienced, please seek urgent medical attention at the nearest A&E department.

 

Following the end of the circuit breaker period, Mount Elizabeth Hospitals and our 24-hour A&E clinics have resumed all healthcare services. If you or your family members require treatment for a medical condition, make an appointment with a specialist.

Our services are also available at other Parkway Pantai hospitals at Gleneagles Hospital and Parkway East Hospital.

Rest assured we have implemented measures to safeguard the health of our patients, visitors and staff. Learn more about how we keep our hospitals safe.

Let us remain COVID-safe and #BeatCOVIDwithME.

 

Article reviewed by Dr Tony Setiobudi, orthopaedic surgeon at Mount Elizabeth Hospital

References

What is Sciatica? Retrieved on 17 June 2020 from https://www.webmd.com/back-pain/what-is-sciatica#1

Sciatica: Symptoms and Causes. Retrieved on 17 June 2020 from https://www.mayoclinic.org/diseases-conditions/sciatica/symptoms-causes/syc-20377435

Low back pain: clinical examination is key. Retrieved on 23 June 2020 from https://www.businesstimes.com.sg/life-culture/low-back-pain-clinical-examination-is-key

Why you need a back-up plan. Retrieved on 23 June 2020 from https://www.businesstimes.com.sg/life-culture/why-you-need-a-back-up-plan

Sciatica: Management and Treatment. Retrieved on 22 June 2020 from https://my.clevelandclinic.org/health/diseases/12792-sciatica/management-and-treatment

Microdiscectomy. Retrieved on 25 June 2020 from https://www.healthline.com/health/microdiscectomy

Laminectomy. Retrieved on 25 June 2020 from https://www.mayoclinic.org/tests-procedures/laminectomy/about/pac-20394533#:~:text=Laminectomy%20is%20surgery%20that%20creates,the%20spinal%20cord%20or%20nerves

Getting a Laminectomy: Before, During, and After. Retrieved on 25 June 2020 from https://www.webmd.com/back-pain/guide/laminectomy-surgery-before-during-and-after#1

Foraminotomy. Retrieved on 25 June 2020 from https://medlineplus.gov/ency/article/007390.htm

What Is a Facetectomy? Retrieved on 25 June 2020 from https://www.verywellhealth.com/facetectomy-4706524#:~:text=A%20facetectomy%20is%20a%20spinal,or%20thickening%20of%20the%20ligament

5 Questions to Answer Before Considering Sciatica Surgery. Retrieved on 22 June 2020 from https://www.hopkinsmedicine.org/health/conditions-and-diseases/back-pain/5-questions-to-answer-before-considering-sciatica-surgery

Sciatica Surgery. Retrieved on 17 June 2020 from https://www.spine-health.com/conditions/sciatica/sciatica-surgery

Is Surgery the Quickest Path to Sciatica Relief? Retrieved from 23 June 2020 from https://www.spine-health.com/blog/sometimes-surgery-quickest-path-sciatica-pain-relief

30.JUN.2020
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Setiobudi Tony
Orthopaedic Surgeon
Mount Elizabeth Hospital

Dr Tony Setiobudi is an orthopaedic surgeon practising at Mount Elizabeth Hospital, Singapore. He specialises in spine conditions, such as lower back pain, scoliosis, slipped disc, sciatica (numbness from lower back to legs), spinal stenosis (narrowing of spinal canal) and ankylosing spondylitis (inflammation of spinal joints). He performs major spine surgery, such as scoliosis correction, correction of a hunchback and spine tumour surgery.