Surgery for sciatica is typically recommended when conservative treatments have failed to provide relief after 6-12 weeks and the patient is experiencing severe, debilitating pain or neurological symptoms. Specific indications for surgery include cauda equina syndrome, severe or progressive neurological deficits like leg weakness or loss of reflexes, incontinence, sciatica on both sides, or pain that is unresponsive to non-surgical treatments. Surgery may also be considered if imaging clearly shows a herniated disc or other structural issue correlating with the patient's symptoms. However, most cases of sciatica (80-90%) improve with conservative management alone, so surgery is usually reserved for patients who have not found relief through other means or who have severe, persistent symptoms significantly impacting their quality of life. The decision to pursue surgery should be made carefully in consultation with a spine specialist after weighing the potential benefits and risks.