How Sciatica Is Treated at Gerling Spine Care and Research Institute
Between 80 and 90 percent of sciatica cases improve without surgery, particularly those caused by disc herniation, where natural resorption of the herniated material occurs over time. Our approach reflects this reality, beginning with conservative care and escalating only when clinically indicated.
Conservative Care
For most patients, particularly those with recent-onset sciatica from disc herniation, conservative care is the appropriate first step. This includes activity modification, anti-inflammatory medications, and physical therapy introduced once the most acute phase has passed. Gentle movement and walking are encouraged, as prolonged bed rest tends to slow rather than accelerate recovery.
Interventional Pain Management
When conservative care is not providing sufficient relief, targeted procedures can reduce nerve inflammation and support recovery. Options include:
- Lumbar epidural steroid injections to reduce inflammation around the compressed nerve root
- Transforaminal selective nerve root blocks to deliver medication precisely to the affected nerve and confirm its role in generating symptoms
- Medial branch block injections when facet joint contribution to pain is suspected alongside radiculopathy
Minimally Invasive and Surgical Treatment
Surgery is considered when conservative and interventional treatments have not provided adequate relief after an appropriate trial, typically six to twelve weeks, or when neurological deficits are significant or worsening. Surgical options are highly effective for sciatica caused by a specific, identifiable structural problem. For sciatica caused by disc herniation, minimally invasive lumbar discectomy or endoscopic discectomy removes the herniated fragment, often producing dramatic relief from radiating symptoms within days. For sciatica caused by spinal stenosis, laminectomy or other decompression procedures create more space for the affected nerve roots. For sciatica associated with spondylolisthesis or spinal instability, lumbar fusion may be recommended alongside decompression to address both the nerve compression and the underlying structural problem simultaneously.