Surgery for lumbar disc herniation and sciatica

What it is

Operations such as discectomy or decompression that remove or relieve pressure from disc material irritating a nerve root.

What taking part usually involves

Surgical work-up, imaging that matches symptoms, recovery time, and physiotherapy afterward. Some people assigned to nonsurgical care in trials later crossed over to surgery. That crossover makes the trial results harder to interpret.

What this is commonly confused with

Generic “back surgery.” Stenosis surgery. Fusion for nonspecific chronic low back pain. Disc regeneration.

What the evidence shows

Versus usual conservative care, surgery can bring faster short-term relief in leg pain and disability. In pooled randomized evidence, the early gap is larger around 6-8 weeks, smaller by 6 months, and about gone by 12 months.

A landmark U.S. trial showed why intention-to-treat and as-treated stories disagree: many people crossed from assigned nonsurgical care to surgery. Intention-to-treat differences were small; as-treated analyses favored surgery. Both readings matter.

NICE considers decompression when imaging matches sciatica. That applies when imaging and sciatica symptoms match; it should not be interpreted as a recommendation for ordinary chronic low back pain.

Who was studied, expectations, and limits

Population and context studied: adults with imaging-confirmed lumbar disc herniation and sciatica who are already in a surgical-candidate conversation.

That describes the population and setting studied; it does not determine whether surgery is right for an individual.

Realistic expectation: faster early relief is the clearest surgical reason; durable superiority is not the default long-term story. Limits: these findings should not be assumed to apply to spinal stenosis, fusion for nonspecific chronic low back pain, or claims of disc regeneration.