What is Nerve Compression?
Written by Neil Badlani, M.D., Chief Medical Officer, North American Spine

Damage from a pinched nerve may be minor or severe. It can cause temporary or long-lasting problems. The earlier diagnosis and treatment for nerve compression occurs, the quicker relief can be found.

It’s not uncommon to hear the term pinched or compressed nerve, but what exactly is it? To thoroughly answer that question, it’s essential to explore the spinal cord, as well the specific nerves that can be compressed.

Nerves are the specialized cells that run from the brain and spinal cord and send messages throughout the body as tiny electrical signals. These messages are called nerve impulses. When a nerve is compressed, the body may send signals in the form of pain.

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More About Nerve Compression

lumbar foraminotomy

A peripheral nerve is a term used to describe one of two components of the nervous system, the other being the central nervous system. Peripheral nerves are composed of 43 pairs of the motor and sensory nerves that branch out from the spine to the arms, legs, muscles, skin as well as the rest of the body and enables the sensation of feeling. There are three types of peripheral nerves and each function in a slightly different way.

Motor nerves send signals from the brain and spinal cord to effectors in the body that include the muscles and skin. This allows the body to perform activities like moving fingers and toes or walking. When motor nerves are damaged, a person may have problems moving body parts or experience muscle spasms and cramps.

Sensory nerves carry messages from muscles back to the brain and spinal cord. The central nervous system is comprised of the spinal cord and brain. Sensory receptors are basically special cells that allow the body to identify environmental changes such as temperature or if an object is hard or soft. These neurons are located throughout the body’s organs such as the skin, eyes, and ears and are receptive to sound, touch, and movement. Sensory nerve damage can cause numbness and tingling in the extremities and sensitivity to touch.

Autonomic nerves regulate the internal organs that control involuntary functions such as sweating, heart rate, blood pressure, and digestion. When the autonomic nervous system is comprised, a person may experience excessive sweating, an increased or decreased heartbeat, abnormal pupil size or sexual dysfunction.

Nerve compression syndrome or compression neuropathy, also commonly called a pinched nerve, is a condition that is caused when too much pressure is placed on a nerve by surrounding tissue. In many cases, this tissue can consist of cartilage, bones, tendons or muscles. When a nerve is compressed, nutrients flowing inside the membrane become reduced or blocked, and it will lose its ability to transmit signals. Consequently, the nerve fibers will no longer function properly which can cause numbness, pain, and a tingling sensation.

What are the symptoms?

Nerve compression can occur in many parts of the body. For example, a herniated disc can put pressure on the nerve in the spine causing lower back pain. Likewise, when a cervical disc slips out of place, the pressure placed on the nerve can cause neck pain. However, the symptoms will impact the part of the body specific to which nerve is affected. Compressed nerve symptoms include:

  • Decreased feeling or numbness in the area affected by the nerve
  • Aching, burning or sharp radiating pain
  • Tingling or the feeling of sharp pins in the affected area
  • Muscle weakness in the area of compression
  • Frequent “fallen asleep” feeling in the foot or hand

Sometimes symptoms of a pinched nerve get worse with specific movements like a head turn. In some cases, pain may be the only symptom, but there can be other symptoms that aren’t accompanied by pain. A pinched nerve that causes neck pain, can run down through the arms and hands to the fingers. And lower back pain stemming from nerve compression usually extends down the leg.

In addition, although less common, a pinched nerve in the thoracic spine can cause pain in the upper back that can be felt in the stomach or chest. Many people incorrectly perceive this symptom to be related to cardiac issues. Those who suspect nerve compression in any part of their body should consult a doctor. 

How is a Compressed Nerve Diagnosed?

A physician will evaluate the symptoms and perform a comprehensive examination. If compression neuropathy is suspected, the following steps are usually taken to form a diagnosis: 

•  Physical Examination:

The doctor will assess pain levels in response to environmental factors or specific actions. The doctor may ask the patient to lie on his or her back and move body parts such as lifting the legs. If the patient experiences pain during specific movements, it can help form a diagnosis.

•  Symptom Assessment:

The doctor will ask the patient a series of in-depth questions to form a complete evaluation. These questions will be specific to the level of pain as well as where and when the pain occurs.

•  Medical History:

As with any condition, the doctor will obtain a full account of the patient’s medical history. Gaining this pertinent information allows the physician to determine if other health conditions are causing the pain.

•  Diagnostic Imaging:

Although in many cases, a pinched nerve can be diagnosed by analyzing the symptoms and a physical exam, imaging tests allow doctors to view internal organs and the affected area and can confirm the diagnosis. This can also allow the physician to understand the severity of the damage.

The symptoms associated with compressed nerve pain will vary depending on which nerve is impacted and how severe the compression is. If pain occurs for more than two or three of days, its best to schedule an appointment with a physician. After diagnosing the cause of the nerve compression, most doctors will create an appropriate treatment plan.

What are the causes of a Compressed Nerve?

low back pain

Nerve compression occurs when there is too much direct pressure placed on a nerve by the tissue that surrounds it. This tissue could be bone or cartilage as with a herniated disc, and sometimes tendons or muscles are the cause. With carpal tunnel syndrome, many tissues may cause the compression of the tunnel’s nerve, including swollen tendons, enlarged bone or a thickened ligament. Many conditions can cause tissue nerve compression, including:

  • Obesity
  • Injury
  • Rheumatoid arthritis
  • Stress from repetitive movements
  • Hobbies or sports

When a nerve is compressed for a short period, the damage is not typically permanent. But if the pressure is lifted, the nerve function will usually perform properly again. However, if the pressure is continuous, it can result in permanent nerve damage which can cause chronic pain. Some health issues such as diabetes, pregnancy, and prolonged bed rest can cause nerves to be more susceptible to compression neuropathy. Although rare, the genetic condition known as Hereditary Neuropathy with Liability to Pressure Palsy can also be a cause. Fortunately, most compressed nerve pain can be successfully treated by a physician.

How are Compressed Nerves treated?

Conservative Options

Conservative treatment options include nerve root blocks and steroid injections. These are designed to provide temporary relief (up to one year), and you may elect to have the procedure done multiple times. Other conservative strategies may include the placement of a spinal cord stimulator–or STIM–which is designed not to correct the underlying degeneration, but to lessen the pain the condition causes.

Decompression

Minimally invasive decompression surgery aims to relieve pressure on the nerves of the spine. This pressure is often caused by stenosis, bulging or herniated discs, and more. Relieving this pressure can be achieved by reducing or removing soft tissue (disc material or scar tissue) or bone (bone spurs, a section of the lamina or foramina) to decompress the affected nerve. When the compression is caused by soft tissue material, a surgical laser may be used to shrink the impinging material.

Fusion/Stabilization

Fusion surgeries are similar in goal–to remove damaged disc tissue and fuse the bones together–but differ in approach, including the use of specialized hardware to reinforce stability, and the location used to gain access to the spine. A related procedure is an artificial disc replacement, in which a damaged cervical disc is replaced with a synthetic disc, and the vertebrae are not fused.

How Much Does Treatment Cost?

Treatment cost depends on several factors, especially what insurance you have and how much of your deductible has been met. IN the last two years, 90% of our patients have paid less than $2000 out-of-pocket. Some have paid literally nothing, and other have paid much more than that. It depends. The good news is: our Patient Care Managers will handle as much as they can directly with your insurance company, and all your costs will be known up-front.

Important note: spine surgery often pays for itself within a year or two. Many people actually spend more money trying to live with the pain than they do getting the pain fixed. The following calculator is intended to give you a sense of what you spend on managing—rather than eradicating—your pain.

 

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This past year you have spent on your pain treatment:

Get surgery now. Getting surgery now is the smartest financial move. Over the last two years, the average North American Spine patient spent around $2,000 out-of-pocket for treatment. You’ve spent that much or more this year to manage your back pain than you could to fix it.

Get surgery soon. Over the last two years, the average North American Spine patient spent around $2,000 out-of-pocket for treatment. At your current rate, you will spend that much or more within the next two years. The sooner you get treatment, the sooner it will pay for itself.

Keep an eye on your spending. Currently, you are managing your pain efficiently from a financial perspective but over time, your expenses could add up. Surgery should be strongly considered if you start missing more work or spending more on treatment medication.

Great job! You are spending very little on your back pain. Keep it up!

Equipment Used in Diagnosis and Treatment of a Compressed Nerve

Some of the diagnostic tests used to diagnose compression neuropathy include:

  • Nerve conduction study: This diagnostic test is also called a nerve conduction velocity (NCV) test and measures the speed at which electrical impulses move through muscles and nerves in the body. During the study, a nerve is stimulated by small currents from electrode patches placed on the skin, and the results can determine if there is nerve damage.
  • Electromyography (EMG): This diagnostic procedure determines muscle abnormalities. During this test, a small needle electrode is inserted through the skin into muscles. It evaluates muscle health by looking at the signal transmission between nerves and muscles. 
  • Magnetic resonance imaging (MRI): This radiology test employs scanners that use strong magnetic fields and radio waves to produce detailed pictures of the organs in the body. This technique is utilized to diagnose a variety of physical abnormalities including nerve compression.
  • High-resolution ultrasound: An ultrasound is a diagnostic imaging technique that uses high-frequency sound waves to view internal structures such as joints, muscles, blood vessels, and other organs. The technique can help in diagnosing certain types of nerve compression such as carpal tunnel syndrome.

A pinched nerve can be diagnosed based solely on the symptoms, but the scans can assist in ensuring that the diagnosis is correct as well as determining the severity of the damage. These scans can also rule out polyneuropathy or multiple nerve damage.

How Does Compressed Nerves Compare to Other Spine Conditions?

There are many terms, that are used in reference to nerve compression. Several people refer to it as a pinched nerve. Some physicians use the term compression neuropathy. Others refer to leg pain as sciatica. The following are some of the terms commonly used to refer to a compressed disc or similar conditions:

  • Bulging Disc
  • Intervertebral Disc
  • Torn Disc
  • Prolapsed Disc
  • Ruptured Disc
  • Collapsed Disc
  • Herniated Disc
  • Herniated Nucleus Pulposus
  • Slipped Disc
  • Disc Extrusion
  • Disc Protrusion

Some of the terms are basically referring to the same condition, while others are quite different. However, they are all related to a stage in the herniation of a disc. Bones or vertebrae on the back of the spine are shielded by small, round flat discs that serve as shock absorbers for the bones along the spine. Herniation usually happens when a disc is pushed out of the annulus. This is usually in the early stages of degeneration. If the herniation remains within the sac, it is called a collapsed or bulging disc. When it tears through the sac, it is referred to as a ruptured, torn or slipped disc.

However, a herniation on the cervical spine can compress the spinal cord thereby pinching and aggravating the nearby nerve causing radicular pain and numbness. This is what causes the sharp pain that radiates throughout the body.

Damage from nerve compression may be temporary or permanent. It can occur from an isolated episode of physical injury or can form repetitive actions over time. In some cases, it can stem from the degeneration of the disc that protects the spine. Early diagnosis and treatment can help relieve the pain and discomfort associated with compression neuropathy.

Analogy: A Tunnel with a Train Track

The nerves of your spine travel like trains on a track. Along their journey, they duck through many enclosed spaces in the vertebrae, like foramen. In order for them to function properly, they must pass through these enclosed spaces cleanly. When structures within your spine collapse like a tunnel on a train track, your nerves can get pinched, trapped, or compressed.

Good Tunnel

Bad Tunnel

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