or nerve pain down the back of your leg

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Find out more about sciatica or nerve pain down the back of the leg
Sciatica - Dr Alex Koefman, spinal surgeon Brisbane - Sciatica treatment Brisbane

Neurosurgeon Brisbane

Dr Alex Koefman about sciatica

Sciatica key points

  • Sciatica is a medical term for nerve pain down the back of the leg.
  • There are only 3 reasons why you would need surgery to treat sciatica: incapacitating pain, symptoms that have been dragging on for a while and a neurological deficit
  • Most people who have sciatica surgery wake up pain free, or very close to it.

Sciatica Brisbane

Some context about nerve pain

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. 

And the resulting pain is always disproportionate. Elsewhere in the body the degree of pain is proportional to the size of the injury. But in the case of spinal nerves, a small piece of disc or arthritic tissue can cause pain to rival a broken heart. I’ve seen international body builders in tears, and I’ve had female patients tell me it’s worse than childbirth.

What is sciatica?

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. The next most common is nerve pain down the arm. We call this brachialgia (literally means ‘painful arm’).

On most occasions sciatica will resolve by itself. Managing a patient with sciatica comes down to a single factor: quality of life.

If you are doing ok, and can manage the pain with medication or physiotherapy then it is usually fine to keep going like this. The majority of the time sciatica, while painful, won’t actually be doing you any physical damage.
Dr Alex Koefman | Brain and Spinal Surgeon Brisbane
Dr Alex Koefman

Spinal surgeon Brisbane

Sciatica surgery Brisbane

Keyhole surgery for sciatica

There is nothing magical about keyhole surgery. All it does is get you out of pain quickly. Most people who have surgery wake up pain free, or very close to it. It’s a rapid way to get your quality of life back if you are struggling or just sick and tired of the pain. 

Usually keyhole surgery is like a bank robbery: I sneak into your spine, take the offending small bit of tissue or disc off the nerve, and then sneak out without leaving much of a trace. The cut is about 1 inch or less, there are no rods, plates or screws, your spine is not weakened as a result.

The best way to describe the effect of surgery is to use an analogy of a rubber band wrapped tightly around your finger. You can do all the bending and stretching exercises on the finger or injections that you want. Alternatively you can take the rubber band off your finger. That is what keyhole surgery does. 

Dr Alex Koefman | Brain and Spinal Surgeon Brisbane
Dr Alex Koefman

Spinal surgeon Brisbane


3 reasons for sciatica surgery

There are 3 reasons I operate on sciatica:

  1. Incapacitating pain. Some patients come in and are close to tears with the severe nature of the pain and need it to stop asap.
  2. The patient has had symptoms dragging on for some time and they are just sick of it not going away, and just need to get back to normal life.
  3. There is a neurological deficit. Sometimes, sciatica can lead to weakness in the foot or ankle. It’s often best to take the pressure of the nerve so the weakness can recover.

Despite the high success rate of keyhole surgery, it is quite common for me to not 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.

Will the pain return after I had sciatica surgery?

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 surgeon Brisbane

What should I do now?

If you are in pain or your symptoms have been dragging on for a while, please contact my team and book an appointment with me. We will go over your personal case and help you to make an informed decision. 

Ready to make an appointment?

Alex consults at Queensland Neurosurgery & Spine Surgery (QNS).
Dr Alex Koefman

Ramsay Specialist Centre
Suite 325
Newdegate St
Greenslopes QLD 4120


(07) 3397 4185

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