# Sciatica: why it hurts and when to operate

> What sciatica is, why the pain runs down the leg, when conservative treatment is enough and when surgery is considered. Reviewed by Dr. Jhon A. Hoyos.

URL: https://brainandspine-bcn.com/en/sciatica-when-to-operate/
Fuente: Brain & Spine Barcelona — https://brainandspine-bcn.com

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# 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.

Lumbar Spine
Published on 28/07/2026
Reviewed by
Dr. Jhon A. Hoyos
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](https://brainandspine-bcn.com/en/herniated-disc-symptoms-treatment/) pressing on the root, followed by [lumbar canal stenosis](https://brainandspine-bcn.com/en/lumbar-spinal-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](https://brainandspine-bcn.com/en/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

- [Sciatica: diagnosis and treatment](https://brainandspine-bcn.com/en/sciatica-treatment-barcelona/)
- [Sciatica: warning signs](https://brainandspine-bcn.com/en/sciatica-warning-signs/)
- [Herniated disc: symptoms and treatment](https://brainandspine-bcn.com/en/herniated-disc-symptoms-treatment/)
- [Lumbar spinal stenosis](https://brainandspine-bcn.com/en/lumbar-spinal-stenosis/)
- [Endoscopic spine surgery](https://brainandspine-bcn.com/en/treatments/endoscopy/)

## 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.

Medical content reviewed by
Dr. Jhon A. Hoyos · Brain & Spine Barcelona
Hospital El Pilar, Balmes 271, Barcelona