For six months I have faithfully followed an exercise program trying to avoid back surgery. But my sciatica is worse if anything. How can I get over the feeling that by having surgery I have failed?

The current standard of care for disc herniation is at least six weeks of conservative care. This usually includes nonsteroidal antiinflammatory drugs (NSAIDs) and physical therapy. Patient education is a large part of the nonoperative approach to this problem.

But doctors know that disc protrusion can be unpredictable. Some patients get better while others get worse. It isn’t easy to tell who will fall into each category. So conservative care is the first step, and if there’s no improvement, then surgery is considered as the next step.

It may be best to redirect your thinking. You did not fail. You faithfully did your program. The program failed you. Having surgery is the next step in the treatment protocol, not a sign of failure.

In studies done by the Spine Patient Outcomes Research Trial (SPORT), 40 to 45 per cent of all patients switch from one treatment group to the other. Some planning surgery get better and don’t need an operation after all. Others trying the conservative route get worse and need the surgery. You are in this second group.

The good news is that surgery is another option when conservative care doesn’t work. And only a very small number of patients (less than five per cent) have complications from this surgery. Most report improvement with sciatica and greater overall function.