More than a sore back
Sciatica is one of the most commonly used spine words and one of the least precise. Patients use it to describe almost any pain below the waist. In practice, true sciatica usually means nerve pain radiating down the leg, often from a disc herniation, stenosis, or instability in the lumbar spine.
The reason precision matters is simple: surgery for sciatica works best when the radiating leg pain, the physical exam, and the MRI all line up. If the symptoms are diffuse, mostly muscular, or disconnected from the imaging, the treatment plan should slow down rather than speed up.
What the workup tries to answer
The evaluation centers on three questions. First, which nerve seems involved? Second, what is compressing or irritating it? Third, is the nerve likely to settle down without surgery? The answer may still be yes even when symptoms are miserable, particularly early in the course of a disc herniation.
Time, anti-inflammatory medication, therapy, and selective injections often help. But persistent leg-dominant pain that keeps patients from sleeping, sitting, driving, or walking normally can make the balance shift toward surgery.
A surgical goal that stays narrow
The point of surgery for sciatica is to treat the structure producing the nerve symptoms with as little collateral disruption as possible. In many cases that means a focused lumbar decompression. In others, especially when there is slip or instability, fusion may be the more stable long-term answer.
Patients often ask whether the MRI finding is “bad enough” for surgery. The better question is whether the anatomy explains the symptoms cleanly enough that surgery has a predictable target.