For people with sciatica, conservative treatments like physical therapy, chiropractic care and non-surgical decompression are usually sufficient. Minimally-invasive microdiscectomy is a common surgical procedure performed on those whose pain has not been relieved by conservative means, or for those who present severe symptoms such as incontinence that require immediate intervention.
A common cause of sciatica is a disc herniation in the lumbar spine. As the exterior ring of the disc weakens, the fluid in the disc’s center begins to leak out and irritate nerves exiting the spine. The sciatic nerve roots exit the spine from vertebrae L4 to S3. Nerve irritation causes sharp, radiating pain from the lower back to the legs, muscle weakness and numbness.
Microdiscectomy entails the removal of the small piece of disc material responsible for impinging the nerve. Many who have had the surgery find that, though pain levels improve, strength does not return to the muscles of the affected leg.
Success rates for microdiscectomy and other spine surgeries are reported to be around 95% by surgeons. However, these rates often reflect that the surgeon was successful in removing a disc piece, or that bones actually fused in a spinal fusion procedure. The actual relief of patients is not always included in the definition of a procedure’s success.
A study of 91 patients with disc herniation and leg paresis (slight paralysis/weakness) who underwent microdiscectomy showed that success rates, in terms of strength recovery, were far from 95%. Only 75% of patients in the study had regained strength in the affected leg a year after surgery. While this represents a majority, a full quarter of participants did not regain strength; this is a notable percentage. See a summary of the study at http://www.ncbi.nlm.nih.gov/pubmed/22193841.
Microdiscectomy is often successful at relieving pain, but it can’t reverse nerve damage that was already done before the procedure. If the sciatic nerve incurred damage that interfered with its ability to send motor and sensory impulses down the leg, this will not spontaneously recover after surgery. This means that, if you have severe muscle weakness to begin with, microdiscectomy may not be a better option than conservative treatments to relieve nerve impingement. Decompression, traction and exercise therapies should be pursued rigorously before considering surgery.
Nerve Regeneration
Nerve damage is often permanent; there is no standard treatment for regenerating the sciatic nerve once damage has occurred. Experimental treatments like stem cell therapy and growth factor therapy are promising options, but access to them is limited. Your best bet for these treatments is to search for trial studies to participate in or to travel out of the country for treatment.
Omega-3 fatty acid consumption, whether from foods or supplements, may encourage nerve repair soon after injury. See http://www.sciencedaily.com/releases/2012/01/120111103856.htm for more on this.
Electrical stimulation of nerves may also help them repair and regrow. This method has been tested on severed sciatic nerves in rats and was shown to promote regeneration. Inquire with local physical therapists, chiropractors and other health professionals about the availability of functional electrical stimulation in your area.
Microdiscectomy treatment is not likely to relieve severe leg weakness, since this is often caused by nerve damage. While it is important to resolve the cause of sciatic nerve impingement, a surgical procedure may not be the best option due to cost, recovery time and risks. While severe nerve damage is often permanent, there are new methods of nerve regeneration being explored.
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