Sciatica Treatment
Quick Answer
Sciatica is nerve pain radiating from the lower back down one leg, most commonly caused by a herniated disc pressing on a nerve root. About 80–90% of cases resolve with conservative care in 4–12 weeks. Dr. Marc Greenberg at Greenberg Spine in Fort Wayne offers the full treatment spectrum — from physical therapy and epidural injections through endoscopic discectomy and microdiscectomy — for patients who don’t improve with conservative care.
Comprehensive care for sciatica using advanced diagnostic techniques and minimally invasive treatments. Dr. Greenberg specializes in identifying the root cause and providing effective relief for sciatic nerve pain.
Experiencing symptoms of sciatica?
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Schedule ConsultationSciatica is pain that radiates along the path of the sciatic nerve, which branches from your lower back through your hips and buttocks and down each leg. The sciatic nerve is the longest and widest nerve in the human body, and when it becomes compressed or irritated, it can cause significant pain and discomfort that affects your ability to perform daily activities.
At Greenberg Spine, we understand that sciatica can be debilitating and significantly impact your quality of life. Our approach focuses on identifying the underlying cause of your sciatic nerve compression and providing targeted treatment to address both the symptoms and the root problem. We offer a comprehensive range of treatment options from conservative care to advanced minimally invasive surgical techniques including microdiscectomy and endoscopic discectomy.
Symptoms
Sharp Leg Pain
Shooting or stabbing pain that travels from the lower back down through the buttock and leg.
Burning Sensation
A burning or electric shock-like feeling along the nerve pathway, often worse when sitting.
Numbness and Tingling
Loss of sensation or pins-and-needles feeling in the leg, foot, or toes.
Muscle Weakness
Weakness in the affected leg or foot, which may affect your ability to walk or stand.
Common Causes
Herniated Disc
Most common cause - disc material presses on the sciatic nerve root.
Spinal Stenosis
Narrowing of the spinal canal compresses nerve roots causing sciatic symptoms.
Piriformis Syndrome
Tight piriformis muscle in the buttock compresses the sciatic nerve.
Spondylolisthesis
Vertebral slippage can compress nerve roots and cause sciatic pain.
Diagnosis
Clinical Assessment
Dr. Greenberg will perform specific tests to identify sciatic nerve involvement and determine the underlying cause of your symptoms.
- Straight leg raise test
- Neurological examination
- Reflex testing
MRI Imaging
Magnetic resonance imaging provides detailed visualization of the spine to identify the exact cause and location of nerve compression.
- Disc herniation detection
- Nerve compression assessment
- Treatment planning guidance
Electrodiagnostic Tests
EMG and nerve conduction studies may be performed to assess nerve function and confirm the diagnosis when imaging is unclear.
- Nerve function assessment
- Muscle activity evaluation
- Severity determination
Conservative Treatment
Most cases of sciatica improve with conservative treatment within 4-6 weeks. Dr. Greenberg typically recommends a comprehensive non-surgical approach as the first line of treatment.
Physical Therapy
Specific exercises to reduce nerve irritation and strengthen supporting muscles.
Medications
Anti-inflammatory drugs, nerve pain medications, and muscle relaxants as needed.
Epidural Injections
Targeted steroid injections to reduce inflammation around the affected nerve.
Heat/Cold Therapy
Application of heat or ice to reduce pain and inflammation.
Activity Modification
Temporary activity restrictions and ergonomic improvements to reduce nerve irritation.
Manual Therapy
Chiropractic care and massage therapy to improve mobility and reduce muscle tension.
When does sciatica need surgery?
Sciatica typically needs surgical evaluation when leg pain, weakness, or numbness persists or worsens despite a thorough 6-to-12-week trial of conservative care — or sooner if you develop progressive foot drop, rapidly worsening weakness, or bowel/bladder changes. The goal of surgery is to relieve pressure on the compressed nerve root so function can return and pain can resolve.
Red flags that point toward surgery
- Progressive weakness — noticeable loss of strength in the leg or foot that worsens over days to weeks, such as difficulty heel-walking or toe-walking, may indicate ongoing nerve injury.
- Bowel or bladder dysfunction — loss of control, new difficulty initiating urination, or saddle-area numbness is a surgical emergency (cauda equina syndrome) that requires immediate attention.
- Severe functional impairment — inability to walk more than short distances, perform daily activities, or work despite adequate conservative care.
- Large disc herniation on MRI — a sizable fragment on imaging that matches the clinical symptoms and is unlikely to resolve sufficiently with conservative measures alone.
When conservative care has been given a fair trial
A meaningful conservative trial typically includes several weeks of directed physical therapy, activity modification, anti-inflammatory or nerve-pain medications, and may include one or more epidural steroid injections. Surgery enters the conversation when, after this trial, leg pain remains disabling, function has not returned to a level that lets you work and manage daily life, or neurological deficits progress rather than improve.
Importantly, surgery is not the next step simply because an MRI shows a herniation — many herniations improve without surgery. The decision turns on how the symptoms are affecting your life and whether the nerve is showing objective signs of ongoing injury.
What sciatica surgery involves
For sciatica caused by a herniated disc, surgery is a discectomy — removal of only the herniated fragment pressing on the nerve, not the whole disc. At Greenberg Spine, Dr. Greenberg performs this through a microdiscectomy (a small incision with the operating microscope) or endoscopic discectomy (a tubular approach through an incision smaller than a dime). Both are typically outpatient procedures. Most patients experience leg-pain relief within days, with graduated return to desk work in 1–2 weeks and fuller activity over 4–8 weeks.
Surgical options for sciatica in Fort Wayne
Dr. Greenberg offers two proven minimally invasive approaches — the right choice depends on the size and location of the herniation, your anatomy, and your recovery goals. Both are discussed in detail during your consultation.
Microdiscectomy
A small-incision procedure using the operating microscope to remove the disc fragment pressing on the nerve. Well-studied with decades of published outcomes.
Learn moreEndoscopic Discectomy
An ultra-minimally invasive tubular approach through an incision smaller than a dime. May offer recovery and less post-operative discomfort for appropriately selected patients.
Learn moreThe best procedure for your situation should be determined during a one-on-one consultation where Dr. Greenberg can review your MRI, examine you, and discuss your goals and expectations.
When to Consider Surgery
Surgery may be recommended when conservative treatments have failed to provide adequate relief after 6-12 weeks, or when there are severe neurological symptoms that require immediate attention.
Surgical Indications
- Severe or progressive muscle weakness
- Loss of bowel or bladder control
- Persistent severe pain after 6-12 weeks
- Significant functional impairment
Why Greenberg Spine
Dr. Greenberg specializes in minimally invasive techniques for sciatica including:
- Endoscopic discectomy
- Microdiscectomy
- Minimally invasive decompression
- Outpatient procedures when possible
Related Procedures
Microdiscectomy
Minimally invasive removal of disc material causing sciatic nerve compression.
Endoscopic Spine Surgery
Ultra-minimally invasive technique for treating sciatica with recovery.
Lumbar Laminectomy
Decompression procedure for sciatica caused by spinal stenosis.
Recovery Expectations
Conservative Treatment
Weeks 1-2
Pain management and gentle movement
Weeks 2-6
Physical therapy and gradual activity increase
Weeks 6-12
Return to normal activities and strengthening
Surgical Recovery
Days 1-7
Immediate pain relief, walking encouraged
Weeks 1-4
Gradual increase in activity, physical therapy begins
Weeks 4-8
Return to work and normal activities
Frequently Asked Questions
When does sciatica need surgery?
Sciatica typically needs surgical evaluation when leg pain, weakness, or numbness persists or worsens despite a thorough 6-to-12-week trial of conservative care — or sooner with progressive foot drop, rapidly worsening weakness, or bowel/bladder changes. At Greenberg Spine, Dr. Greenberg performs two minimally invasive approaches: microdiscectomy and endoscopic discectomy, both typically outpatient.
What is sciatica?
Sciatica is pain that radiates along the path of the sciatic nerve, which branches from your lower back through your hips and buttocks and down each leg. It's typically caused by compression or irritation of the nerve roots that form the sciatic nerve.
How long does sciatica last?
Most cases of sciatica resolve within 4-6 weeks with conservative treatment. However, severe cases or those caused by structural problems like large disc herniations may require longer treatment or surgical intervention for complete resolution.
When should I see a doctor for sciatica?
See a doctor if you experience severe pain, numbness, weakness in your leg, or loss of bowel or bladder control. Also seek medical care if pain persists beyond a few weeks or significantly impacts your daily activities and quality of life.
Related Topics
Learn more about related conditions and treatments
About this content
This page was written and clinically reviewed by Marc Greenberg, MD, a fellowship-trained spine surgeon who trained at Mayo Clinic, Johns Hopkins, and Brown University, practicing in Fort Wayne, Indiana. Information is for educational purposes only and is not a substitute for medical advice from your physician.
Ready to Find Relief from Sciatica?
Schedule a consultation with Dr. Greenberg to identify the cause of your sciatica and explore treatment options.
Schedule ConsultationMedical Disclaimer: The information provided on this page is for educational purposes only and should not be considered medical advice. Always consult with a qualified healthcare provider for proper diagnosis and treatment recommendations. Individual results may vary.
Source: American Association of Neurological Surgeons (AANS) and North American Spine Society (NASS) clinical guidelines.