Sciatica is leg pain that follows the path of the sciatic nerve — typically from the lower back, through the buttock, and down the back of the leg. Most cases improve with conservative care. When intervention is needed, the endoscopic approach addresses the source without fusion.
What sciatica is, and what it isn't
Sciatica is a symptom, not a diagnosis. The name describes the path: pain that radiates down the back of the leg following the sciatic nerve. The cause is usually compression of one of the lower lumbar nerve roots — most commonly L5 or S1 — by a herniated disc, a narrowed foramen, or occasionally a piriformis-related compression in the buttock.What looks the same on the surface — leg pain — can have meaningfully different sources. The job of the evaluation is to identify which, because that determines what (if anything) needs to be done.
When surgery makes sense
The default answer for new sciatica is patience and a structured trial of conservative care. Anti-inflammatories, time, physical therapy, and sometimes a targeted epidural steroid injection resolve the great majority of cases within a few months. The body resorbs many disc herniations on its own.Surgery becomes appropriate when the pain persists past a fair trial, when weakness develops, or when daily life keeps shrinking around the symptom. The endoscopic option fits most single-level herniations and many foraminal narrowings; the surgeon can usually predict from the MRI which patients will respond well.
What the procedure looks like
Endoscopic discectomy enters through an incision less than ⅓ inch and uses a pencil-sized lighted tube to reach the herniation. Only the fragment compressing the nerve is removed; the rest of the disc and the surrounding architecture is left intact. The work is done under local anesthesia with light sedation, and most patients are home the same day.Send your MRI for a free review
Dr. McMillan reviews each scan personally. You get a candid answer about candidacy before any travel or scheduling.
What the consultation actually looks like
The initial visit with Dr. McMillan focuses on what your imaging actually shows and what your symptoms are telling us — independent of what you’ve been told previously. The $250 consultation fee covers his time to review your MRI personally and give you a candid evaluation. Most patients leave the visit with a clear answer: either you’re a candidate for the endoscopic approach (and we discuss what that would involve in your specific case), or you’re not (and we tell you why, and what we would suggest instead). No high-pressure scheduling, no surprise add-ons.
For patients traveling from outside the Upstate, the consultation can usually be coordinated with the procedure to minimize travel. A typical out-of-town pathway is: send your MRI for the free review, have a phone or video conversation with Dr. McMillan after his review, and travel for a single combined visit-and-procedure schedule when you decide to move forward. The office handles the logistics — lodging recommendations, transportation guidance, and post-op coordination with your local primary care physician.
If you have been told you need a fusion and you are not sure, or if you have been managing this with conservative care that has stopped working, the next step is the free MRI review. There is no obligation and no cost to send your scan. Dr. McMillan reviews each one personally. The response will tell you plainly whether the endoscopic approach fits your specific anatomy, or whether your situation calls for a different plan.
Recovery and what comes next
Many patients notice the leg pain settle within 2–5 days as the inflammation around the nerve resolves. Walking expands across the following weeks; back to most normal activities by 2–4 weeks for many patients, though heavier work follows a longer timeline. Recovery is highly individual, and follow-up confirms the result.Bottom line
Sciatica is leg pain that follows the path of the sciatic nerve — typically from the lower back, through the buttock, and down the back of the leg. Most cases improve with conservative care. When intervention is needed, the endoscopic approach addresses the source without fusion.
If you’ve been told you need a fusion — or you’re trying to avoid one — a free MRI review is the most useful next step. Dr. McMillan reviews each scan personally and tells you candidly whether the endoscopic approach fits your specific anatomy.
For patients dealing with sciatica surgery, the conversation comes down to specifics: what your imaging actually shows, what your symptoms are actually telling us, and which procedure (if any) genuinely matches that pattern. The candid answer is sometimes that you do not need surgery yet; the candid answer is sometimes that you do, but a smaller operation than the one you have been quoted. A second-opinion MRI review separates those cases and gives you the information you need to make the decision well.
The Synergy approach to sciatica surgery
Sciatica surgery addresses the specific nerve root compression that produces leg pain — and at Synergy that means endoscopic decompression of the offending nerve, not fusion or open laminectomy. Most patients arrive at Synergy Spine Center after being told fusion is their only surgical option locally. The practice exists precisely to reassess that recommendation: when imaging shows pathology that endoscopic decompression can address, decompression is what’s recommended — without locking the segment permanently through fusion. For sciatica surgery specifically, the typical pathway begins with the free MRI review, which produces a written assessment of candidacy and the specific procedure recommended.
For candidates, the most common procedure is endoscopic discectomy — performed through an incision less than ⅓ inch, under local anesthesia, with same-day discharge. The procedure takes about an hour to perform; most patients are walking the same afternoon. For background on the underlying pathology, see lumbar radiculopathy which covers the diagnostic workup, symptoms, and full treatment options in detail. Bundled transparent pricing — surgeon, facility, anesthesia, and post-op all included — is published at /spine-surgery-cost-transparent-pricing/.
Recovery is meaningfully faster than from open or fusion surgery. Office workers typically return within one to two weeks; manual labor takes four to six weeks. For out-of-town patients, consultation and procedure are combined into a single visit using the 3-day plan. The practice’s overall surgical philosophy — and the rationale for the no-fusion-first orientation — is documented at /no-fusion-promise/ and /our-philosophy/. Authoritative clinical background on the underlying condition is available at NIH NINDS — Sciatica.
Frequently asked
How long should I try non-surgical treatment first?
Most clinicians recommend a fair trial of 6–12 weeks of structured non-surgical care before considering surgery, absent red flags. Many sciaticas resolve in that window without intervention. For a personalized candidacy assessment based on your specific imaging, submit through the free MRI review — Dr. McMillan reviews each scan personally with a written response within several business days.
What are the red flags that change the timeline?
New numbness in the saddle area, loss of bowel or bladder control, or rapidly progressing weakness warrant immediate evaluation, not a wait. For background on the specific condition most often diagnosed in this context, the lumbar radiculopathy page covers symptoms, diagnostic workup, and full treatment options.
Is the endoscopic approach as effective as open microdiscectomy?
Randomized trials report comparable results for lumbar disc herniation with fewer complications for the endoscopic approach. The technique matters: the right operation for the right patient. Out-of-town patients typically combine consultation and procedure into a single trip — see the 3-day plan for typical cadence and the medical travel cost for planning purposes.
How big is the scar?
The incision is less than ⅓ inch, and the surrounding skin is not stretched as it would be for an open procedure. Most patients have a small dressing rather than a long bandage. For background on the specific condition most often diagnosed in this context, the lumbar radiculopathy page covers symptoms, diagnostic workup, and full treatment options.
Will I need physical therapy?
Most patients benefit from a short course of guided therapy in the weeks after the procedure — mostly to rebuild core support and walking tolerance. The exact program varies. Out-of-town patients typically combine consultation and procedure into a single trip — see the 3-day plan for typical cadence and the medical travel cost for planning purposes.
Can sciatica come back?
Recurrence at the same level happens in a small percentage of patients over years. Lifestyle measures — weight management, core strength, avoidance of repetitive heavy lifting — reduce the risk. For the most common surgical procedure offered for these pathologies, see the endoscopic discectomy page which covers technique, anesthesia, recovery, and bundled pricing.
How this page was prepared
This page summarizes the clinical approach taken at Synergy Spine Center for the topic above. It is based on peer-reviewed literature, professional society guidelines (NASS, AAOS), federal patient education resources (NIH, AHRQ, CMS), and Dr. McMillan’s experience as Director of Spinal Medicine and Endoscopic Spinal Surgery. Outcome language is qualified. Individual results vary. Pricing where shown is current for 2026 and may change.
References
- Ruetten S, et al. Full-endoscopic vs microsurgical discectomy, randomized trial. — source
- OrthoInfo — sciatica patient education. — source
- NINDS — back pain and sciatica information. — source
- NIH NINDS — Sciatica — authoritative reference for sciatica surgery.
- AAOS OrthoInfo — Sciatica — authoritative reference for sciatica surgery.
Synergy Spine Center publishes patient education content for general information only; it is not medical advice and does not establish a physician-patient relationship. For specific medical guidance, schedule a consultation. No identifiable patient information is included on this page.