Sciatica: why it hurts and when it needs surgery
Sciatica is the pain that runs along the sciatic nerve from the lower back to the leg. We explain what causes it, when it improves on its own and when surgery is considered.
Sciatica is the pain that runs along the sciatic nerve from the lower back or buttock down the leg. In most cases it is not a disease in itself, but the symptom of a nerve root compressed in the lumbar spine. The most frequent cause is a herniated disc, followed by canal stenosis. The pain is usually described as burning, cramping or an electric shock. Most cases of sciatica improve within 6 to 12 weeks with conservative treatment. Surgery is considered when the pain is disabling and does not respond, when there is progressive loss of strength, or in the presence of neurological warning signs.
What sciatica really is
Sciatica is not a diagnosis in itself but a symptom: an irritated or compressed nerve root in the lumbar spine that projects pain along the leg. Identifying which root is affected and why is the first step towards the right treatment.
Why it hurts: the most common causes
The leading cause is a herniated disc pressing on the root, followed by lumbar canal stenosis. Less often, other causes narrow the space through which the nerve travels.
When conservative treatment is enough
In most people the pain settles within 6 to 12 weeks with pain relief, physiotherapy, staying active within tolerable limits and, in selected cases, injections. Prolonged bed rest is discouraged.
When surgery is considered
Surgery is weighed up when the pain remains disabling despite correct treatment, when there is worsening loss of strength, or in the presence of warning signs. See Sciatica: warning signs.
Surgical technique: microdiscectomy
When the cause is a herniated disc, the reference technique is microdiscectomy: minimally invasive, it removes only the fragment compressing the root through a small incision, relieving leg pain quickly and with a short recovery.
Related information
Frequently asked questions
Does sciatica heal on its own?
In most cases it improves within 6 to 12 weeks with conservative treatment. Surgery is reserved for pain that does not respond or for neurological warning signs.
How long does sciatica last?
Most episodes improve within 6 to 12 weeks. If intense pain persists beyond that, it should be reassessed.
Is sciatica surgery dangerous?
Microdiscectomy is a common, minimally invasive procedure with good outcomes and a low complication rate when well indicated.
Is walking good for sciatica?
Gentle, tolerable activity usually helps; prolonged rest is discouraged. Movement should stay within the pain you can tolerate.
Leg pain that won't go away?
The team assesses your case and advises you on the best treatment for your sciatica, from physiotherapy to minimally invasive surgery.