Sciatica refers to pain radiating along the distribution of the sciatic nerve due to irritation or compression of lumbosacral nerve roots. While many cases improve with conservative therapy, a distinct subset develops persistent or progressive symptoms that necessitate surgical evaluation. Sciatica with surgical indication is defined by structural pathology producing ongoing nerve root compression with correlating clinical deficits or refractory pain despite adequate non-operative management.

Clinical features include radiating leg pain, often sharp or electric in quality, associated with numbness, paresthesia, or weakness in a dermatomal pattern. Symptoms are frequently exacerbated by sitting, coughing, or forward flexion. Red flags indicating surgical consideration include progressive motor weakness, significant sensory loss, intractable pain limiting function, or signs of cauda equina syndrome such as bladder or bowel dysfunction.

Neurosurgical assessment emphasizes correlation between clinical findings and imaging. Magnetic resonance imaging is essential to identify causative pathology, commonly lumbar disc herniation, lateral recess stenosis, foraminal narrowing, or less frequently tumors or infections. Concordance between symptoms, neurological examination, and imaging determines surgical candidacy and guides operative planning.

Surgical management aims to decompress the affected nerve root, relieve pain, and prevent irreversible neurological damage. The choice of procedure is dictated by the underlying pathology and may include microdiscectomy, decompressive laminectomy, or targeted foraminal decompression. The principle of maximal effective decompression with minimal tissue disruption underpins surgical decision-making.

Outcomes are favorable when surgery is performed for well-defined indications, with many patients experiencing rapid relief of radicular pain and gradual neurological recovery. Early intervention in the presence of motor deficit improves the likelihood of functional restoration. Postoperative care includes early mobilization, pain management, and structured rehabilitation to reduce recurrence risk.

Sciatica with surgical indication represents a precise neurosurgical diagnosis requiring timely intervention to restore nerve function and improve quality of life.