Surgical treatment of discogenic sciatica

Abstract

The evaluation of physical, psychological, social, and occupational factors are recommended in patients with discogenic sciatica. Surgical discectomy may be considered in selected patients with sciatica due to lumbar disc herniations that fail to resolve with conservative management for at least 6-8 weeks, or in patients with cauda equina syndrome. An appropriate pre-operative work up including neuroimaging is necessary. Surgery has been shown to be highly effective; shortening the time to recovery by around 50% compared to nonsurgical treatment. Whether one specific surgical procedure is better than other remains uncertain. Methodological limitations of studies evaluating the efficacy of percutaneous methods prevent ultimate conclusions. Post-operative complications occur in 1-3% of cases. If patients are appropriately selected, failures happen in less than 10% of cases. The most common modes of failure include recurrent disc herniation and fibrosis. Failed back surgery syndrome is also a challenge for spinal surgeons.