What is a Pinched Nerve?
A pinched nerve occurs when pressure is applied to a nerve by surrounding tissues such as bones, cartilage, muscles or tendons. The pressure impacts the nerve’s function and causes pain, tingling, numbness or weakness. Nerves can become pinched by herniated, bulging discs or bone spurs which can cause pain. The damage by a compressed or pinched nerve can be minor or major and should be treated to avoid long-term problems. It is important to see a spine specialist to get a proper diagnosis and treatment for the pinched nerve. If a pinched nerve is not treated, in some cases it can cause irreversible damage such as weakness in the muscles and loss of sensation.
A pinched nerve is a direct compression or pressure on a nerve either from the disc, ligament or the surrounding bony structure in the foramen. Any number of conditions may cause a pinched nerve including an injury or repetitive movement. Poor posture, smoking, and heavy lifting are additional actions that can cause spinal or disc degeneration. Once a nerve becomes pinched, an inflammation process begins that may cause neck or low back pain. The pain can radiate from the neck to the shoulder and arm (cervical radiculopathy) or down the leg (Sciatica). Some conditions that may cause tissue to compress a nerve or nerves include: injury, stress from repetitive work, obesity, hobbies, sports activities, rheumatoid or wrist arthritis. If a nerve is pinched for only a short period of time, there is usually no permanent damage. If the pressure is not relieved, chronic pain and permanent nerve damage can occur.
The most common symptom of a pinched nerve is a tingling sensation which can also include numbness. Initially, this symptom can come and go, but can become more over time. The following are some of the symptoms:
- Sharp or dull pain in the lower back which may worsen with physical activity
- Muscle Spasms
- Sciatica (Pain, burning, electrical, tingling and numbness that extends from the buttock to the leg or foot)
- Leg Weakness
- Loss of leg function.
In more severe cases, muscle weakness may occur because the nerve that controls the muscle is irritated. If this symptom is not treated, the muscles may decrease in size and function. If nerve compression goes untreated for a long period of time, the protective area around the nerve can breakdown and cause swelling, severe inflammation and scarring. This can lead to peripheral neuropathy, carpal tunnel syndrome and servere pain.
A Pinched Nerve will be diagnosed based on medical history, physical examination, and diagnostic tests such as an x-ray, MRI and CT scans. There are many options for treating a pinched nerve that include both non-operative and surgical treatments. First, conservative treatments may be used which include rest, physical therapy, chiropractic care, and non-surgical anti-inflammatory drugs such as epidural steroid injections. If the pain persists and there is evidence by CT Scan, MRI or X-ray of neurological deficit, then surgical intervention may be the next recommendation. The following treatments are used to treat pinched nerves:
- Endoscopic Discectomy – A 1/2 inch incision is made on the back and a portion of the offending disc is removed.
- Endoscopic Foraminalplasty – A small 1/4 inch incision is made in the skin to allow for the physician to selectively remove bone and relieve the pinched nerve.
- MIS Laminectomy – The nerves are freed by removal of the lamina or posterior part of the vertebra and spinal ligament.
- Foraminotomy – The foramen is removed to reduce pressure on the nerve. Foramen are the openings on the sides of the vertebra which spinal nerves exit the spinal column.
- MIS Microdiscectomy – This surgery removes herniated disc material that is compressing a nerve root or the spinal cord by using a microscope or surgical loupes.
- MIS TLIF Spinal Fusion – Two or more vertebrae are immobilized with surgical rods and screws. Bone graft is placed in the space between the vertebrae to encourage growth of the bones together.