The decision between pursuing surgery or conservative care

When dealing with sciatica, nerve damage, and “pinched nerves” the decision between pursuing surgery or conservative care can be a daunting one.

Mechanical pressure on a nerve can cause a conduction block which can result in numbness or profound weakness. This blockage of the nerve can also cause congestion of the fluid in the veins surrounding the nerve further exacerbating pain and discomfort.

If the pressure on the nerve has not been applied for too long (i.e. weeks vs months), the block can be reversed and the symptoms will go away. For example, a large amount of mechanical pressure from a massive disk herniation will cause a reduction in blood flow to the nerve root. This is called ischemia. Ischemia can cause nerve damage. Even though the amount of mechanical pressure is relevant, so too is the speed of onset and the amount of time the pressure is exerted.

The bottom line is that the decision to have surgery for sciatica should be based on several factors including a thorough history, physical exam, MRI findings, and at least 2 medical opinions.

Source: Jesson, Tom. Sciatica: The Clinician’s Guide. Book 1: What is it?.