I had a lumbar discectomy eight months ago for terrible sciatica. Unfortunately, I still have the pain. It is better, but not by much. Should I have a second surgery? It seems like the only option left open to me.

Sometimes, in a small number of cases, surgery for sciatica just doesn't help as expected. Pain relief may be minimal to non-existent. Some patients are able to go back to work, while others go on disability.

Doctors are working hard to figure out why some people are helped by surgery and others are not. If they can find a way to predict the results, then surgery can be advised or discouraged accordingly.

Each patient would be evaluated for his or her positive or negative risk factors in making this decision. So far, several predictive factors have been identified. These include axial joint pain (arms or legs) and overall pain levels and location.

Psychosocial issues and claims status are also important. A recent study of this issue showed that there was no probability of a good or excellent outcome when the patient exhibited psychiatric factors. The same was true for patients involved in personal injury claims. Workers' compensation cases werre only slightly more likely to be helped by surgery.

Based on these results, surgeons are more cautious in recommending revision procedures.