For severe sciatica lasting more than 6 months, with worsening nerve pain radiating from the buttock to leg, MRI findings of grade I retrolisthesis (L3/L4), disc bulges, hypertrophy, and especially nerve root impingement at L4, spine surgery may be indicated if conservative treatments like physiotherapy and TCM have failed.

When Surgery Is Recommended
• Surgery is typically considered if nerve-related symptoms (pain, numbness, weakness) continue to worsen despite 6–8 weeks (or longer) of non-surgical management.

• Relevant MRI features include nerve root impingement, structural instability (retrolisthesis), and persistent annular fissures with neurological impairment.

• Common procedures for your MRI findings may include microdiscectomy, laminectomy, foraminotomy, or sometimes fusion, especially if instability is present.

• Surgery is almost always considered in the presence of significant, progressive neurological deficits or intolerable, persistent pain affecting quality of life.

• It’s important to discuss with a spine surgeon, as some patients gain adequate symptom relief with image-guided injections or continued conservative care, especially if weakness, severe numbness, or cauda equina syndrome is not present.