What are the surgical options if epidural treatment fails to remedy my sciatica?

Sciatica is unique compared to other lower back problems because it causes back pain as well as severe pain, tingling, and other sensations down the length of your leg. When this type of pain persists despite epidural treatment, it may be time to explore your surgical options.

The team at Pennsylvania Orthopedic Associates in Huntingdon Valley, Pennsylvania, have years of experience successfully performing surgery to relieve sciatica. They’re available to talk about whether you’re a good candidate for surgery. In the meantime, here’s a rundown of your surgery options.

When you become a candidate for surgery

When the sciatic nerve is inflamed, irritated, or compressed at the lower spine, you’ll have lower back pain and symptoms along the nerve as it travels through your buttocks and down your leg. In addition to pain that’s often severe, you may experience sensations such as tingling, numbness, burning, and prickling. You can also develop muscle weakness in the affected leg.

Sciatica treatment begins with conservative therapies. It’s important to follow a gentle exercise regimen or undergo physical therapy, and your doctor may prescribe medications such as muscle relaxants.

Your doctor may also perform an epidural steroid injection, delivering steroids into the spinal space near the nerve to reduce swelling and diminish pain, at least for a time.

When you’ve exhausted conservative therapies and you still suffer with pain or your symptoms worsen, your doctor at Pennsylvania Orthopedic Associates may recommend surgery.

Surgery options for sciatica

Most cases of sciatica are caused by a herniated disc that pushes against the nerve. However, the nerve can also be compressed by other conditions such as bone spurs, degenerative disc disease, and spinal stenosis (narrowing of the spinal canal).

The type of surgery you’ll receive depends on which procedure is best for repairing your underlying problem. These are the types of surgeries most often performed for sciatica:

Discectomy or microdiscectomy for herniated disc

Surgery to repair a herniated disc is called a discectomy when it’s done as open surgery or a microdiscectomy for those undergoing minimally invasive surgery. During a discectomy, your doctor at Pennsylvania Orthopedic Associates removes the herniated portion of the disc or the entire disc, depending on the extent of the damage.

Decompression surgeries

When your sciatica is caused by a condition other than a herniated disc, you have several surgical options for decompressing the nerve. These procedures create more space for the nerve by opening the bony canals through which the nerve travels.

Laminectomy or laminotomy

At the back of each vertebra is a bony plate called the lamina. During a laminectomy, your doctor at Pennsylvania Orthopedic Associates removes all or part of the lamina together with part of the facet joint and thickened ligaments.

The procedure is called a laminotomy when a small portion of the lamina and ligament are removed, leaving most of the bone — and the support it provides to the spine — in place.


An open canal in each vertebra, called the foramen, allows the sciatic nerve to leave the spine. When this area is responsible for your pinched nerve, your doctor performs a foraminotomy to remove bone around the opening.

Surgical procedures to stabilize your spine

If you only have part of a herniated disc removed, the remaining disc can heal on its own, so spinal stabilization usually isn’t necessary.

However, surgery that changes the structure of your spine affects the spine’s strength and stability. Your doctor restores stability by either replacing the old disc with an artificial disc following a discectomy or by performing a bone fusion.

During a bone fusion, your doctor inserts a bone graft between two vertebra. The graft allows the bones to grow together and fuse into one bone, which restores stability and alleviates pain.

If you continue to suffer with pain due to sciatica, call Pennsylvania Orthopedic Associates, or book an appointment online to talk about your surgical options.

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