Surgery for sciatica

Is surgery right for sciatica?

Surgery for sciatica is not a one-size-fits-all decision. Most people recover well through movement-based care and physical therapy. Surgery is usually considered when severe leg-dominant pain, weakness, or numbness continues despite several weeks of guideline-based conservative care.

Common reasons your doctor might discuss surgery include:

• Persistent pain that limits daily life activities like walking, sitting, or sleeping.
• Progressive weakness or numbness in the leg or foot.
• Imaging that shows a herniated disc pressing directly on a nerve root that matches your symptoms.

For most people, sciatica improves naturally as swelling around the nerve decreases or the disc fragment shrinks. Because many recover without surgery, doctors often recommend trying non-surgical care first. The best plan is made together with your care team, based on your goals, pain levels, and daily function^{1 2 3}.

Common surgical options for sciatica

If surgery is discussed, these are the most common procedures:

• Lumbar Microdiscectomy: Removes the small part of the herniated disc pressing on the nerve root. It aims to relieve leg pain caused by nerve compression.
• Endoscopic Discectomy: A minimally invasive version of microdiscectomy using a small camera and instruments through a tiny incision.
• Laminectomy (Decompression): Removes a portion of bone or ligament to widen the spinal canal, often for sciatica caused by spinal narrowing (stenosis).
• Spinal Fusion: In select cases with instability (like spondylolisthesis), vertebrae may be fused together to prevent painful movement.

Each option is chosen based on the cause of the nerve irritation, your overall health, and your activity goals—not a fixed timeline^{3 4}.

What to expect during recovery

Recovery from lumbar surgery varies from person to person and depends on the exact procedure and pre-surgery fitness.

• Early Phase (0–2 weeks): You may have mild incision pain but often notice leg pain relief soon after surgery. Walking short distances is encouraged.
• Intermediate Phase (2–6 weeks): Gradual increase in activity, focusing on mobility and safe lifting or sitting.
• Rehabilitation Phase (6–12 weeks): Strength and flexibility exercises help protect your spine and reduce recurrence risk.

Possible side effects of surgery include fatigue, local stiffness, or mild wound discomfort. Risks include infection, blood clots, nerve injury, and recurrent disc herniation (around 7–9% within two years)⁵.

Studies show that while surgery may relieve leg pain faster, long-term pain and function outcomes are similar to those who continue structured, non-surgical care^{6 7}. Preparation, realistic expectations, and active rehabilitation all improve recovery.

Can surgery be avoided?

In many cases, yes. Exercise-based physical therapy, education, and staying active can relieve pain and restore function without surgery. Research shows that even when imaging confirms a disc herniation, two-thirds of cases improve naturally as the body reabsorbs the disc material⁸.

Structured physical therapy programs that combine movement, strength training, and guidance on posture or pacing can match long-term surgical outcomes for many people⁶.

Sword Health’s digital program has shown recovery rates comparable to traditional in-person therapy, with high satisfaction and lower dropout rates in people with back pain.

If pain or weakness continues despite a strong rehab effort, a surgical consultation can help you understand your options.

How Sword can support you before and after surgery

Physical therapy can play an important role in preparing for surgery, supporting recovery, and, in some cases, helping people manage symptoms without surgery. Sword offers physical therapy programs designed to support you at different points along that journey.

Sword supports recovery before and after surgery, with care designed to fit into your life. You receive high-quality physical therapy at home, guided by licensed clinicians and supported by smart technology.

• Care that adapts as your body and recovery needs change
• Licensed physical therapists guiding your care at every stage
• Non-invasive, evidence-based physical therapy programs

Support for preparation, recovery, and long-term movement health

Clinical insight

Major clinical trials show that early surgery speeds pain relief, but long-term results are similar to continued high-quality conservative care^6,7. Current NICE guidelines recommend surgery only for persistent, disabling leg pain that matches imaging findings or for emergencies like cauda equina syndrome³.