Sciatica That Won’t Go Away: When Should You See a Spine Surgeon?

Most sciatica gets better without surgery. That's the honest starting point.

Research published in the BMJ found that the majority of acute sciatica cases improve within a few weeks, with roughly half of patients reporting improvement within 10 days and around 75% improving by four weeks. Other studies estimate that 80% to 90% of sciatica cases resolve without surgery using rest, physical therapy, and anti-inflammatory medication.

But that leaves a real group of people for whom the pain doesn't fade. Longer-term data tells a less reassuring story for this group:

• One cohort study found 30% of patients still had troublesome symptoms at one year, with 20% out of work and 5–15% eventually requiring surgery
• Another found 55% still had sciatica symptoms two years later
• Once sciatica passes the 12-week mark, it becomes less responsive to conservative treatment

If you're past the "give it time" window, this guide covers what's actually happening, which symptoms mean you shouldn't wait any longer, and what a spine surgeon does — and doesn't — do about it.

What Sciatica Actually Is

Sciatica isn't a diagnosis — it's a symptom. It describes pain traveling along the sciatic nerve, which runs from your lower back, through the hip and buttock, and down the back of each leg.
The pain happens because something in your lower spine is pressing on or irritating a nerve root. The most common causes:

• Herniated or bulging disc — the source of roughly 90% of sciatica cases, and clinically known as lumbar radiculopathy
• Spinal stenosis — narrowing of the space around the nerves, more common with age
• Spondylolisthesis — one vertebra slipping forward over another
• Piriformis syndrome — a muscle in the buttock irritating the nerve, with no disc involvement at all

The cause matters more than the label. It determines whether physical therapy will help, whether an injection makes sense, or whether the nerve is compressed in a way that won't resolve on its own.

Why Sciatica Sometimes Doesn’t Improve

A herniated disc can shrink over time as the body reabsorbs the material — this is part of why many cases resolve without treatment. But it doesn't happen for everyone, and it doesn't follow a predictable timeline.
Sciatica is more likely to persist when:

• The herniation is large or presses directly on a nerve root, rather than bulging near it
• The cause is spinal stenosis, since bony narrowing doesn't shrink the way disc material can
• A structural issue like spondylolisthesis mechanically keeps the nerve compressed
• The nerve has been compressed long enough that irritation has progressed toward nerve damage

None of this is something you can diagnose by paying closer attention to your own pain. It requires imaging and an exam from someone trained to read both.

Symptoms That Mean You Should Stop Waiting

Time is a reasonable strategy for the first several weeks. These symptoms are not:

• Progressive weakness. Foot slapping the ground when you walk (foot drop), frequent tripping, or being unable to push up on your toes on the affected side. This means the nerve is losing function, not just signaling pain — and it can become permanent without treatment.
• Spreading or worsening numbness. Occasional pins-and-needles is common with nerve irritation. Numbness that's expanding, or an area that feels completely dead to touch, signals more significant compression.
• Loss of bladder or bowel control, or numbness in the groin or inner thighs (saddle anesthesia). This combination is called cauda equina syndrome. It's a surgical emergency — go to the emergency room, don't wait for an appointment. It's rare, but it's the one scenario here where delay risks permanent damage within hours.
• No improvement after 6–8 weeks of real conservative treatment. If you've done physical therapy, taken anti-inflammatories as directed, and modified activity, and nothing has changed, that's a signal the compression isn't resolving on its own. Clinical guidelines generally support considering surgery after 8 weeks, and preferably after 14–16 weeks, of conservative care that hasn't worked.
• Pain severe enough to disrupt sleep and daily function for weeks. Chronic, disabling pain is a legitimate reason for a surgical evaluation on its own — even without weakness or numbness. You don't need to "prove" your pain is bad enough to get seen.

What a Spine Surgeon Actually Does at This Stage

Seeing a spine surgeon does not mean you're getting surgery. It means getting an evaluation from someone who can tell you accurately whether surgery is a reasonable option — and just as often, tell you it isn't yet.

A typical evaluation includes:

• A physical and neurological exam — testing reflexes, strength, and sensation to map which nerve root is affected
• Imaging, usually an MRI, to see disc herniations, nerve compression, and stenosis in soft-tissue detail (X-rays alone don't show this)
• A review of what's already been tried and how you responded to it
• A direct conversation about the actual options — injections, further therapy, or a specific type of decompression surgery, depending on the cause

On the surgery itself: The most common procedure for a herniated disc causing sciatica is a microdiscectomy, removing the portion of disc pressing on the nerve. A large randomized trial found that outcomes for conservative care and surgery were comparable at 26 weeks — which is part of why surgeons don't rush to operate. Surgery moves from "an option" to "the right option" when the nerve isn't recovering on its own or when symptoms are urgent.

Sciatica vs. General Lower Back Pain

Not all back pain that radiates is sciatica, and treating the two the same wastes time.

• A lumbar strain or back strain involves muscles and ligaments, not nerves. It usually improves with rest and physical therapy alone.
• True sciatica involves nerve-specific symptoms: numbness, shooting pain down the leg, or weakness.
• If your pain stays in your lower back and doesn't travel down the leg, get it evaluated for what it actually is before assuming it's sciatica.

What to Bring to the Appointment

Coming prepared makes the first visit more useful:

• A timeline — when the pain started, and whether it's improved, worsened, or stayed flat
• What you've already tried, including specific medications and how many physical therapy sessions you completed
• A clear description of any numbness, tingling, or weakness, and exactly where
• Any prior imaging, even from another provider

FAQ

The Bottom Line

Sciatica that resolves in a few weeks doesn't need a surgeon. Sciatica that's still disrupting your life after two months, that comes with weakness or spreading numbness, or that involves any loss of bladder or bowel control needs an evaluation—and the last one needs emergency care right now.

The team at Elite Orthopaedics includes board certified orthopedic specialists who can determine whether your sciatica needs continued conservative management or a closer look with imaging and a surgical opinion. Our concierge-level orthopedic care model is built around a direct, unhurried evaluation instead of a rushed referral chain. Our Gaithersburg office is a good starting point if you're ready to get evaluated.

This article is for informational purposes and isn't a substitute for a medical evaluation. If you're experiencing loss of bladder or bowel control or numbness in the groin area along with back pain, seek emergency care immediately.