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A member asked:

When will a doctor suggest looking into surgery for sciatia pain? have been on prednisone and hydrocodone off and on since january of this year for sciatia pain. painkillers and steroids are not working this time around and have been taking the prednisone

4 doctor answers9 doctors weighed in
Dr. Peter Ihle
Orthopedic Surgery 56 years experience
When : When there is neurological finding, increasing neurological signs, pain is intractible, and physical exan localizes the involved nerve root. Then plain films including obliques, followed by an MRI l spine.
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Dr. Carl Spivak
Orthopedic Spine Surgery 30 years experience
Disk : Disk herniation can be treated with rest, physical therapy, medications, steroid injections and surgery. Surgery is a good treatment if the disk is causing severe leg pain and you have failed other conservative treatments i mentioned. Today disk surgery can be done extremely minimally invasive through the spine endoscope. Please see my health guide on lumbar disk herniations. Good luck!
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Dr. David Cooke
Internal Medicine 31 years experience
Surgery : Surgery is only helpful in a minority of cases of sciatica, mainly when a neurological deficit (e.g. Loss of reflexes, true (not pain-related) weakness). If these are not present, physical therapy is usually the first step, and helps in the majority of cases. Although commonly prescribed, there is little evidence that Prednisone and other oral steroids are helpful. Vicodin and other opiate pain medications can give some symptom relief, but don't fix the problem. Non-opiate medications such as Gabapentin and nortriptyline can often be quite helpful. Non-surgical interventions such as epidural steroid injections and nerve blocks can often help considerably. Additionally, the majority of sciatica does improve within 3 months, regardless of treatment. With your duration of symptoms, you should go for physical therapy if you have not already done so. An MRI of the spine is probably reasonable at this point, but don't get too hung up on the findings. Most people with no back pain have abnormal mri's, so don't assume that any MRI findings are the cause of your pain. Mri is frankly most useful for ruling out serious, unexpected disease. Surgery should generally be reserved for those with serious neurological abnormalities, or those who have failed all of the above and have neurological findings. Otherwise, there is a high risk that having surgery won't help, or even make matters worse.
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Dr. Qamar Khan
Pain Management 19 years experience
Given Your Pain: I would suggest seeing a pain/spine specialist to evaluate you further to evaluate what level and what can be done to treat you. There are interventional treatments besides medications and surgeries that might reduce or eliminate the pain altogether. If you've already done this then maybe surgery is the right option for you.
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Last updated Oct 4, 2016


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