The spaces inside the spine where the nerves sit are normally very small. It therefore doesn’t take much to jam a nerve and cause pain.
The resulting pain is often disproportionate. While pain elsewhere in the body tends to match the size of the injury, with spinal nerves, even a small piece of disc or arthritic tissue can be agonising. I’ve seen international body builders in tears, and I’ve had female patients tell me it’s worse than childbirth.
To get technical, sciatica specifically describes nerve pain travelling down the back of the leg. But nerve pain can also travel down the front of the leg or even down the arm. The mechanism is exactly the same however. It’s caused by a small disc fragment or arthritic tissue jamming a spinal nerve somewhere in the spine.
Sciatica is the most common form of nerve pain. The next most common is nerve pain in the arm, known as brachialgia (literally ‘painful arm’).
On most occasions sciatica will resolve by itself. The key to managing sciatica is focusing on one factor, quality of life.
If you’re managing OK with medication or physiotherapy, keep it up. Most of the time sciatica, while painful, won’t cause lasting physical damage.
I treat sciatica with Keyhole surgery. It isn’t magical, but it is designed to relieve pain quickly. Most patients wake up pain-free, or nearly pain-free. It’s a rapid way to get your quality of life back if you are struggling or just sick and tired of the discomfort.
I often describe keyhole surgery as a professional heist, much like a Hollywood film. With great care and precision, I enter your spinal area, carefully remove the offending fragment or disc from the nerve, and exit—leaving hardly any trace. The cut is about 1 inch or less and there are no rods, plates or screws; your spine is not weakened as a result.
There are 3 reasons to undertake surgery.
The patient has had symptoms dragging on for some time and are sick of it. They just need to get back to normal life.
Despite the high success rate of keyhole surgery, I often choose not to operate for sciatica. A lot of the time a steroid injection and physiotherapy is very effective and patients feel their quality of life, while not 100%, is close enough that they can move around fairly freely.
Whether you have surgery or not, management of sciatica is only about one thing: quality of life.
Once the pain has gone, the biggest worry is the chance of it coming back again down the track. This sometimes plays on a patient’s mind and robs them of their confidence in movement. The good news is it is possible to reduce your risk of recurrent sciatica, whether you’ve had surgery or not, and regain your confidence in movement. I will describe these strategies to you when I see you.
On a last note, know that it is common for nerve pain to play tricks on your brain. It is common for the pain to affect you emotionally, mentally and physically. People often suspect I have bias for surgery because I’m a surgeon. They are correct, I do like surgery. But it is also true that I don’t underestimate the effects of pain on the brain. And I would encourage you to have a limit to the brave face you put on, as there are options to get you out of trouble.
Sciatica surgery is generally safe when performed by an experienced spinal surgeon (whether a neurosurgeon or orthopaedic surgeon). However, like any surgery, there are risks, including infection, nerve damage, or complications from anaesthesia—though these are very rare. By using a minimally invasive keyhole approach, with smaller incisions and quicker operations (often less than an hour), the risks are kept as low as possible.
Sciatica often resolves on its own with conservative treatments like physiotherapy, pain management, and lifestyle changes (such as avoiding heavy lifting and improving posture). Steroid injections can also be effective. While there’s no guaranteed permanent cure without surgery, many patients successfully manage their symptoms through non-surgical approaches. However, if nerve pain remains unbearable or worsens, surgery may be the best option for improving your quality of life.
If you have sciatica, several healthcare professionals can assist, depending on the severity of your symptoms. General practitioners (GPs) are usually the first step for diagnosis and initial treatments like pain management or referrals. Physiotherapists can help with exercises to alleviate pain. For more severe cases, a neurosurgeon or spinal surgeon may be required to assess if surgery is necessary.
If you’re in pain or your symptoms have been dragging on, it doesn’t have to be this way. Contact my team and book an appointment with me to review your case, examine options, and figure out the pathway to less pain.
