Surgery for a Pinched Nerve

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?

Decompression surgery for a pinched nerve may be required for patients who have chronic pain and limited mobility and who have not found relief from their symptoms through nonsurgical, conservative treatment.

Pinched Nerve Symptoms

The pain, nerve damage, and irritation caused by a pinched nerve is sometimes minor but other times severe. pinched nerve symptoms can come and go or become chronic. Because the pain may come and go, it is sometimes mistaken for arthritic pain.

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.

Facet Thermal Ablation and Laser Debridement

The Bonati Facet Thermal Ablation uses a laser to deaden sensory nerves that are irritating the facet joints and causing pain. During the procedure, our spine surgeons vaporize irritated and painful nerves around the facets of the vertebrae. Dilating Tubes and Laser are utilized to remove pain-inducing tissue in nerve branches above and below the affected facet joints on the spine.

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 55,000 the Bonati Spine Procedures have been successfully performed with a patient satisfaction rate of 98.75%.