What it is
"Sciatica" is a symptom, not a diagnosis — it describes pain radiating from the lower back through the buttock and down the leg along the path of the sciatic nerve. The most common underlying cause is a lumbar disc herniation pressing on a nerve root, though piriformis syndrome, spinal stenosis, and less commonly, tumors or cysts can produce a similar pattern.
The pain can range from a dull ache to a sharp, electric-shooting sensation. Most people with sciatica from a disc herniation improve significantly over 6–12 weeks as the herniation resorbs and nerve root inflammation resolves.
When it gets better on its own
The natural history of lumbar disc herniation with sciatica is reassuring for most patients. Studies consistently show that 70–90% of patients improve without surgery. The herniated disc material is often absorbed by the body's own immune cells over weeks to months.
Conservative management — rest in the acute phase, followed by progressive mobilization, physical therapy, and sometimes an injection — is appropriate as long as the patient is improving and does not have alarm signs.
When surgery is considered
Microdiscectomy is considered when:
- Sciatica persists and has not improved despite 6–12 weeks of appropriate non-operative treatment
- Progressive motor weakness develops (particularly foot drop, which is a more urgent indication)
- Pain is severe and disabling, making an adequate trial of conservative care difficult to complete
- Bowel or bladder dysfunction develops (cauda equina syndrome — a surgical emergency)
Surgery for sciatica, when the patient is correctly selected, has a very high rate of relief of the leg pain component. Back pain is more variable.