What is a Pinched Nerve?
Nerve impingement, or compressed nerve, is a term used to describe a nerve or group of nerves that have become impinged by bone, ligament, tendons, and soft tissue.
Though pinched nerves can occur anywhere throughout the body, they are most common in the lower back. The nerves in the spinal cord travel through the foramina, small openings between the vertebrae through which spinal nerve roots exit to other parts of the body. These small openings can become obstructed and pinch the nerves. Most cases of pinched nerves appear in the lower back.
Overview
The body’s nerves are most vulnerable at places where they travel through narrow spaces. As a result, nerve compression often occurs when the nerve is pressed between ligament, bone, and tendons. Although a pinched nerve may not be a life-threatening issue, it can cause back or neck pain and other symptoms that affect a patient’s everyday life.
Anatomy
The nerves, which are part of the body’s peripheral nervous system, extend from the brain and spinal cord throughout the body sending messages to the muscles and skin. Nerves that leave the spine and go into the arms or legs are called peripheral nerves. A peripheral nerve has millions of nerve fibers that exit the spinal cord and branch out into muscles and skin.
The peripheral nervous system is divided into three systems, the somatic nervous system, sensory nervous system, and autonomic nervous system. The somatic nervous system transmits signals from the brain to end organs, such as muscles. The sensory nervous system transmits signals for senses like taste and touch to the spinal cord and brain. The autonomic nervous system is the self-regulating system of the body, which influences organ function.
When the sensory nervous system is interrupted due to a compressed nerve, patients will begin to receive warning signal, such as low back pain.
Causes of a Pinched Nerve
Pinched nerves develop when the nerves are compressed by tissue, muscle, bone, cartilage or tendons. Pinched nerve causes are often attributed to:
- Overuse
- Exercise and sports
- Injuries
- Poor posture
- Obesity
- Genetics
- Herniated discs
Herniated discs are the most common pinched nerve causes in the back between the vertebrae of the spine. This condition occurs when the gel-like center of a vertebral disc (the nucleus pulposus) breaks through the outer ligament (the annulus fibrosis) of the intervertebral disc. This bulge of extruded material puts pressure on the adjacent nerve root, causing it to function improperly and send pain signals. The discs that are most prone to herniations are those in the cervical spine and the lumbar spine because these are the most flexible vertebrae.
Symptoms of Pinched Nerves
Most people have experienced the symptoms of a pinched nerve when an extremity, for example, a hand, foot, or leg, “falls asleep”. To alleviate these symptoms of pinched nerves, a change in body position is usually all that is required. In the case of a pinched nerve in the back, however, further measures may be required.
A pinched nerve in the back may be the result of further back problems such as a herniated disc in your lower spine causing sciatica to radiate pain down the back of your leg. Pinched nerve symptoms may vary, depending on the location of the nerve or nerves involved.
Common Pinched Nerve Symptoms
- numbness or decreased sensation to the area
- sharp, aching or burning pain
- tingling “pins and needles” sensations
- muscle weakness
- frequent feeling of foot or hand has fallen asleep
Symptoms of Pinched Nerves in the Lumbar Spine
Lumbar disc herniations most often occur between lumbar segments 4 and 5, and lumbar segment 5 and sacral segment 1. Herniations at these levels compress the L5 nerve and the S1 nerve. Pinching of the L5 nerve can cause numbness, pain, burning and tingling sensations to radiate out from the affected area down the inner thigh and leg to the big toe. Pinching of the S1 nerve can cause radiating pain down the outer leg to the ankle and the sole and side of the foot.
Symptoms of Pinched Nerves in the Cervical Spine
Cervical disc herniations occur less frequently than lumbar disc herniations because less force is exerted on the cervical spine. When nerve roots in the cervical spine are compressed or “pinched”, the result can be radiating pain to the arms. If the sensory nerves between the first and second or second and third cervical levels are pinched, severe, chronic headaches can also result.
Symptoms of Pinched Nerves in the Thoracic Spine
Although less common than pinched nerves causes from lumbar or cervical herniations, a thoracic herniated disc may lead to myelopathy (spinal cord dysfunction), progressive neurological deficits, or intolerable pain. Typically, these symptoms occur following an acute traumatic disc herniation with myelopathy. The surgery to address these symptoms, employing a decompression, is designed to take the pressure off the spinal cord or nerve root. In some cases, pinched nerve symptoms may include a combination of these sensations, depending on the extent of the damage and the compression of the nerve.
Diagnosing a Pinched Nerve
Beginning with a physical examination, the doctor will perform or request specific testing to determine if you are suffering from a compressed nerve. This along with a review of the patient’s symptoms and diagnostic imaging such as X-rays, CT and MRI studies will allow the doctor to provide an accurate diagnosis. Radiculopathy is a nerve disorder caused by a compressed nerve in the spine. Lumbar radiculopathy and cervical radiculopathy are the most common. A patient with a pinched nerve may be diagnosed with radiculopathy. Patients may also feel nerve compression in their neck which can lead to peripheral neuropathy.
Pinched Nerve and Herniated Disc
Each intervertebral disc has a gel-like center, the nucleus pulposus, which can break through the outer ligament, the annulus fibrosis. When the nucleus breaks through, it is known as a herniated disc. Herniated discs can lead to a pinched nerve as the bulging or extruded disc material puts pressure on the adjacent nerve root. Herniated disc are most common in the cervical and lumbar spine as these are the most flexible vertebrae and account for most of the motion of the spinal column.
If you have been diagnosed with a herniated disk, your physician may request diagnostic testing to determine if you are suffering from a pinched nerve as well. An individual who has previously been diagnosed with a herniated disc may need testing to determine if their pain is a result of a herniated disc or a combination of a herniated disc and pinched nerve.
Pinched Nerve and Sciatica
Sciatica is a term used to describe leg pain caused by the pinching of the sciatic nerve, which runs from the hip down through the leg. Pain from a pinched sciatic nerve can radiate down the leg and into the foot and toes.
Sciatica can be painful and debilitating at times. If you are experiencing sciatica symptoms, your physician will recommend diagnostic testing, such as an x-ray or CT scan, to pinpoint the precise location of the pinched nerve.
Risk Factors
Although a pinched nerve is not a life-threatening condition, for many it can impede on their everyday life. There are many factors that can increase the risk of an individual suffering from nerve compression.
Some common risk factors include:
- Poor posture
- Rheumatoid arthritis
- Thyroid disease
- Diabetes
- Jobs or hobbies that lead to repetitive hand, shoulder, or back movement
- Obesity
- Genetics
Exams & Tests
A nerve conduction study, also known as a nerve conduction velocity test, measures the electrical impulses the nerves are sending. During the test, a nerve is stimulated with a surface electrode patch attached to the skin while another electrode records the resulting electrical activity. Test results can reveal if you have a damaged nerve.
During an electromyography, the doctor will insert a needle electrode through the skin and into various muscles to evaluate the electrical activity of your muscles when they contract and when they are at rest.
A magnetic resonance imaging test, MRI, may also be completed in order to diagnose the issue.
Pinched Nerve Treatment
When conservative pinched nerve treatment such as physical therapy and medications fail to relieve the symptoms unique to a pinched nerve after a few weeks, additional intervention, such as back surgery, may be required to relieve the source of the compression or pinched nerve. Surgical procedures can relieve the pain by taking the pressure off the nerve.
The spine procedures vary depending on the location of the pinched nerve. For instance, if the sciatic nerve is involved, it may be the result of a ruptured disc, arthritis, degenerative disc disease, or other abnormalities of the lower back.
The Bonati Spine Surgery For Pinched Nerves in the Neck or Back
For the past 30 years the Bonati Spine Institute has been providing lasting relief for patients suffering from a pinched nerve using the Bonati Spine Procedures. These patented procedures offer an array of surgical techniques to treat this condition that may include:
Foraminotomy for Pinched Nerves
A foraminotomy is a decompression surgery performed in order to increase the space of the foramen and hollow out the passageway where the nerve roots exit the spinal canal. The procedure involves the removal of bone or tissue that obstructs the neuroforamen and compresses the nerve roots leading to inflammation and radiating pain. The removal of part of the lamina is often necessary for the surgeon to gain access to the affected nerve roots in the neuroforamen. For this reason the foraminotomy is often performed in conjunction with a laminectomy or laminotomy.
Laminectomy for Pinched Nerves
A laminectomy is a surgical procedure performed to treat spinal stenosis. The surgery is designed to relieve pressure (decompress) on the spinal cord or spinal nerve roots through the widening of the spinal canal. The procedure is carried out by removing or trimming part of the lamina (roof) of the vertebrae in the compressed area. The removal of part of the lamina creates an opening for the compressed nerves, relieving pressure on the nerve roots and reducing inflammation. The partial removal of the lamina may also allow the surgeon to remove any bone spurs or damaged tissue causing pain and inflammation in the patient.
Laminotomy for Pinched Nerves
A laminotomy is a common decompression surgery for spinal stenosis that resembles the laminectomy in its goals and technique. The difference between the laminectomy and the laminotomy is that the laminotomy involves making an opening in the lamina to gain access to the disc, where the laminectomy necessitates the removal of the lamina section of the vertebrae. In either case the goal is similar, to relieve pressure on the affected area and allow the nerve roots room to heal. Both procedures are often utilized in order to give the surgeon the proper space to perform the foraminotomy.
The Bonati Spine Institute encourages patients with pinched nerves to contact us to request a no-obligation MRI review or discuss your conditions with our medical professionals. Find out why The Bonati Spine Procedures are considered to be among the world’s best solutions when it comes to advanced spine surgery. Your pain from a pinched nerve can become a thing of the past.
Surgery for a Pinched Nerve
Surgery for a pinched nerve may be required once the symptoms caused by pressure on the spinal nerves have become chronic or severe. The Bonati Spine Procedures utilize patented instruments and techniques to treat chronic pain caused by pinched nerves in the lumbar, cervical or thoracic spine. The Bonati Spine Procedures can quickly and efficiently relieve the pain caused by a pinched nerve by removing the pressure on the nerves. The procedures are performed on an outpatient basis, under conscious IV sedation with local anesthesia. Patients often report immediate relief as the pressure is removed. The patient is able to walk out shortly after the procedures and return to normal, pain-free life. Many of our patients return to work within days of their procedure.
A pinched nerve in the spine occurs when the structures in the vertebral spine degenerates and/or narrows so that the spinal nerves are compressed. When this narrowing occurs, one or more nerve roots in the spine may become compressed or pinched, and cause back or neck pain and other symptoms including radicular pain that may radiate to the extremities.
A spinal nerve is most vulnerable at places in the body where they travel through narrow spaces, such as entering or exiting the spinal column, where there is little soft tissue to protect them. Nerve compression often occurs when the nerve is pressed between tissues such as tendon, ligament, or bone. A pinched nerve can occur throughout the body, but the most common are in the back, specifically in the lower back.
When Is Surgery for a Pinched Nerve Done?
For patients who have had chronic pain and limited mobility, decompression surgery may be required to relieve their symptoms. These operations take place when all other methods fail; they’re not common but sometimes necessary in order for someone with pinched nerves (and thus nerve roots)to function normally again.
Pinched Nerve Symptoms
A pinched nerve is not something you want to ignore. The pain and irritation caused by a pinched nerve can be minor or it might become chronic, depending on the severity of symptoms that come up after being injured (e). Sometimes these feelings are mistaken for arthritis since they both have similar intensity levels at first glance; however with further examination we discover these pains actually arise from different sources–a nagging little discomfort versus severe crippling restrictions in movement!
Pinched nerve symptoms include:
- Pain in the compressed area such as neck or low back
- Numbness and tingling that radiates to the extremities
- Burning or pins and needles sensations
- Pain that worsens after exercise, waking up from sleeping, or bending and walking
- Muscle weakness
Causes of a Pinched Nerve
Although a pinched nerve is caused by compression on the nerve root, there are many ways that nerve endings can be compressed.
- A herniated disc or bulging disc pressing on the nerve root
- Wear and tear associated with aging inflammation
- Poor posture
- Obesity
- Repetitive motions that irritate or wear down tissue
- Injury or trauma
- Bone spurs that narrow the spinal canal
- Arthritis and degenerative joint diseases
Pinched Nerve Pathology
L5 (lumbar 5) and S1 (sacral 1) are the two nerves most commonly pinched in the lumbar spine.
- Pinched L5 nerve – impingement of this nerve affects the muscles of the foot and toes
- Pinched S1 nerve – impingement of this nerve leads to weakness in the large gastrocnemius muscle in the back of the calf
Most cervical pathology leads to compression of the C6 or C7 nerve roots in the neck, although sometimes the C5 or C8 nerves may be pinched.
- Pinched C5 nerve – shoulder pain, weakness, and sometimes shoulder numbness
- Pinched C6 nerve – weakness in the biceps and wrist extensors, pain and/or numbness radiating down the arm and into the thumb
- Pinched C7 nerve – pain/numbness that radiates down the back of the arm and into the middle finger
- Pinched C8 nerve – pain in upper back, outside of arm down to little and ring fingers
Who is a Candidate for the Procedure?
Your physician may recommend a surgical intervention after a series of conservative treatments have not provided relief from pain and given you the ability to return to your regular activities. Your physician will order diagnostic tests such as an MRI or CT scan to determine which nerves are compressed.
The Bonati Spine Procedures for a Pinched Nerve
The Bonati Spine Procedures are safe and highly effective alternative to traditional open back surgery and spinal fusion. They achieve great results in decompressing nerves to treat pinched nerves and many other spinal conditions. The Bonati Spine Institute offers an array of procedures to treat a pinched nerve, which may include:
Foraminotomy / Foraminectomy
A foraminotomy/Foraminotomy is a surgical intervention that relieves pressure on nerves that are being compressed at the site of the intervertebral foramina, also called neural foramen. This pressure can cause inflammation and pain. Foramina are small openings present between every vertebra in the spine. Nerve bundles that connect to the spinal cord pass through these openings to form the peripheral nervous system.
Laminotomy/Laminectomy
This spinal surgery is performed to decompress the spinal nerves by making an opening in the lamina that creates space and gives the nerve roots room to heal. Part of the lamina is cut away to expose the ligamentum flavum and an incision is made to access the compressed nerve.
Discectomy
A discectomy is a procedure in which a part of a herniated or bulging disc is removed to relieve pressure on the pinched nerves and nerve roots.
Before Surgery
Do not eat or drink after midnight the day prior to your surgery. If you smoke, try to quit and exercise regularly to improve your recovery rate. Do not drink alcohol the night before and the day of your procedure.
There are some medications that can increase your risk of bleeding and other complications during any surgical procedure. Your physician will discuss any medications you take regularly and give you specific instructions on how long before surgery to stop taking them. In general, the following medication should be withheld for seven days to two weeks prior to surgery:
- Aspirin, Plavix, and other blood thinners
- Anti-coagulants
- NSAIDs such as Ibuprofen, Naproxen, Aleve, and Advil
- Arthritis medications
- Vitamins and herbal medicines as they may interact with the anesthesia
Follow the exact instructions your surgeon or physician gives you to prepare for surgery and manage any medication before and after surgery.
During Surgery
All Bonati Spine Procedures are performed with conscious IV sedation and local anesthesia. This allows direct communication with the surgeon during the procedure to pinpoint the pain and facilitate its alleviation. Often, patients are asked to complete a series of mobility exercises to verify that the pain has been successfully treated.
During surgery, a small incision will be made and a tubular retractor and small surgical instruments will be used to remove any bone or tissue that is compressing the nerve roots.
After Surgery
Your surgeon will give you a specific exercise/recovery plan to help you return to normal activities as soon as possible. Patients are often able to start walking therapy immediately after their procedure and return to work and other daily activities within days. You may also be prescribed medication to help with any discomfort.
Recovery Time from Pinched Nerve Surgery
Because The Bonati Spine Procedures do not involve a large incision, they avoid extensive damage to the muscles surrounding the spine. This generally results in less pain after surgery and a faster recovery. The length of recovery time may vary, but most patients are walking the same day and back to everyday activities within days.
More than 75,000 the Bonati Spine Procedures have been successfully performed with a patient satisfaction rate of 98.75%.
