I’ve had sciatica for six months now. It just never seems to go away no matter what I try. I saw a surgeon but he couldn’t guarantee the operation would work. Why is it so hard to tell if surgery would be helpful?

Conservative care is usually the first-line of treatment for lumbar radiculopathy (sciatica). Most patients get better with a combination of treatment in the first six to eight weeks. Anti-inflammatory drugs, physical therapy, and exercise are used most often to obtain relief from painful symptoms.

But when non-operative measures fail, then surgery may be the next step. Imaging studies identify the underlying pathology. It could be a herniated disc, bone spur, or cyst that’s putting pressure on the spinal nerve causing the radiculopathy. Removing the cause of the problem seems to work in about 80 per cent of all surgical cases.

But what about the other 20 per cent? These are the patients who fail both conservative and surgical treatment. Studies show that certain psychosocial factors may be to blame. The presence of anxiety, depression, worry, fear, and other psychologic traits actually predict a negative outcome from treatment.

Patients who report joint pain in the extremities along with sciatica are also more likely to have a poor outcome after surgery. The joint pain is not caused by irritation of the spinal nerve. And it is not relieved by decompression surgery to remove pressure on the nerve.

Patients who are involved in personal injury claims or worker’s compensation claims are also at increased risk for poor results. Patients with any of these risk factors may want to proceed with surgery carefully or not at all.

You may want to ask your surgeon for a psychologic or psychiatric evaluation prior to scheduling the operation. There are several tests that can help identify emotional and psychologic distress. The results may predict your relative risk for a poor, fair, good, or excellent outcome.