What is a Pinched Nerve in the Spine?

Written by Neil Badlani, M.D., Chief Medical Officer, North American Spine

When changes to the spine cause the cartilage, bones, muscles, tendons or other tissues to put too much pressure on a nerve, this is known as a pinched or damaged nerve. The pressure stops the nerves from working correctly, instead resulting in weakness, numbness, pain, or tingling.

It’s possible to feel the pain of a compressed nerve anywhere in your body for any number of reasons. For example, you may feel pain down the back of your legs and in the lower back if a herniated or ruptured disk is compressing a spinal nerve. With some rest and other self-care treatments, the majority of people experiencing a compressed nerve will heal on their own in just a couple of weeks. In some cases, surgery could be required when the pain is severe.

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More About Pinched Nerves

lumbar foraminotomy

Sometimes, the cause of this pressure is due to bone or cartilage, such as when a spinal disk has become dislodged and ended up pressing against a nerve. Other times, damaged or inflamed tendons or muscles could be the culprit. A variety of tissues, such as degenerated or thickened ligaments, could all be responsible for pressuring the spinal cord and the nerve roots attached to it.

If the nerve has been pinched for only a few days, you’re unlikely to suffer any permanent damage. Once whatever causes the pinching ceases, nerve function works just like it did before the swelling. However, if the pain persists, then there is risk of permanent damage or at least chronic pain. 

If any of the following apply to you, there is an increased risk of pinching a nerve:

  • Sex: Women have smaller carpal tunnels, making it more likely to experience compressed nerves in the wrists. There does not appear to be an increased risk for pinching a spinal nerve, however. 
  • Bone spurs: Trauma, osteoarthritis, and other conditions can all cause bone thickening, which can cause bone spurs to develop, stiffening the spine and reducing the available space for the nerves inside to move. 
  • Thyroid disease: Those with thyroid disease are more likely to experience pain from compressed nerves. 
  • Rheumatoid arthritis: When rheumatoid arthritis causes inflammation, the spine is much more likely to pressure the nerves within, causing pinching pain. 
  • Overuse: Excessive lifting at work or around the house, especially in warehouse settings, increase your risk of compressed nerves. 
  • Diabetes: Nerve compression is more common in those who have diabetes. 
  • Obesity: Likewise, nerve compression is more common in the obese. 
  • Pregnancy: Water and baby weight is still weight, meaning the pregnant are also more likely to experience compressed nerves.

What are the symptoms?

A tingling sensation is the most reported symptom of a compressed nerve, followed by some numbness in the area. At first, this might come and go with some downtime in between, but it will grow persistent over time left untreated. Then, you may experience pain along with the tingling, a sensation patients tend to describe as “electrical” or an otherwise sharp pain. Some report the pain to feel more like burning instead.

More extreme cases of compressed nerve can result in muscle weakness. This is because the nerve controlling the muscle in question has become inflamed and otherwise irritated. Continuing to leave the nerve untreated can cause the muscle to reduce in size and function–it will experience atrophy.

The back is not the only place where you can pinch a nerve. Some other common places include:

  • Carpal tunnel: In the wrist when the median nerve is injured 
  • Lateral femoral cutaneous nerve: The sensory nerve to the upper thigh 
  • Ulnar nerve: At the elbow, often caused by leaning on elbows 
  • Cervical spine: In the neck, which may cause pinched nerve pain in the shoulder blades 
  • Sciatic nerve: Pinched nerve pain may travel from the lower back down into the leg

How to Diagnose Pinched Nerve in Back or Neck

Seeing a spine specialist will allow you to determine which specific nerve is affected depending on where you are feeling the pain. Of course, self-reporting is sufficient; you will also need to undergo a comprehensive exam, including a physical exam of the shoulders and neck. Your reflexes, strength, and sensation may also be tested by performing certain movements or stretches. 

Be sure to provide as many details as possible about the pain you are feeling, such as when it first began and what activities exacerbate the pain. Also be sure to demonstrate the movements that provide relief to the area. The doctor will also likely want to know if there have been any changes to your normal level of physical activity. If an injury occurred, you’ll need to provide details about that as well. Finally, because spinal nerves can affect a great percentage of your health, be sure to inform your doctor if your bladder function or bowel habits have changed. 

In order to diagnose a pinched nerve in back or neck, x-rays and an MRI are likely. The X-ray highlights details and any changes that have occurred to the vertebrae, but it doesn’t provide any information about the disks in between the vertebrae or the nerves within. The purpose of the X-ray is to show how narrow the spine has become and whether any bone spurs have grown or not. 

Because the X-ray is not sufficient on its own, an MRI is necessary to diagnose a compressed nerve. The MRI can produce images of the spinal disks and the nerves inside without exposing the patient to any radiation. 

If there is pain in the shoulder, an ultrasound may also be added to examine the shoulder’s soft tissue, to rule out an injured tendon or ligament as the culprit of the pain. 

What are the causes of a Pinched Spinal Nerve?

low back pain

Like the name suggests, a pinched spinal nerve occurs when a nerve in the spine becomes pinched due to pressure from surrounding tissue. There are a few potential culprits, such as:

  • Repetitive motions
  • Holding the body in an awkward position for too long without stretching or adjusting
  • Poor posture. 

The most vulnerable nerves are the ones that travel through the narrowest parts of your body, which is why it’s important to protect your spine–especially since there is a decreasing amount of soft tissue around them to protect them. Compression happens when the nerve becomes pinched between bones, tendons, or ligaments. 

How are Pinched 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.

Calculate how much you've spent on back pain this year.
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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 to Diagnose and Treat Compressed Nerve in the Spine

If the doctor believes you have a compressed nerve in the spine, there are several tests that he or she may order, such as:

  • Nerve conduction study: The doctor may test muscle function and nerve impulses using electrodes on the skin, measuring nerve signals when subjected to small electrical impulses. 
  • Electromyography (EMG): The doctor inserts electrodes into the skin via needles to monitor the muscles’ electrical activity both at rest and when contracting. The results can indicate damage to the nerves that lead to the muscle rather than in the spine itself. 
  • MRI: As previously mentioned, an MRI can produce powerful images of parts of the body, pinpointing where nerves have been pinched. 
  • High-resolution ultrasound: If needed, an ultrasound can build a different set of images of the inside of your body, which can provide further information on where nerves have been compressed.

How Does a Pinched Nerve Compare to Similar Conditions?

pinched spinal nerve tends to be obvious, though treating the underlying cause is the only way to fully relieve the compression at all. If you have a compressed nerve and have been feeling exhausted or numb, it’s worth talking to your doctor about the possibility of multiple sclerosis. 

Although it sounds alarming, it is also worth noting that the condition affects less than 1 percent of Americans, and the condition does mimic a number of other health problems. So how can you tell if the problem is multiple sclerosis or another condition? MS symptoms tend to first gradually appear between the ages of 20 and 40, and then the symptoms get worse. Dizziness also accompanies the symptoms of MS.

  • Beginning gradually
  • Goes away occasionally 
  • Back pain
  • Worsens when walking
    other activities
  • Relief with rest

Leg pain while walking, also known as claudication, can also be caused by arterial circulatory insufficiency, or it could be caused by spinal stenosis. In both cases, the pain decreases with rest, but the stenosis patient needs to sit for several minutes to ease their lower back pain. With arterial circulatory insufficiency, the pain stops as soon as the patient stops moving. 

Likewise, in the case of lumbar stenosis, sitting will stretch ligaments in such a way that leg pain and other symptoms go away, but then they come back should the patient sit upright. Be sure to treat the right condition.

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, or trapped.

Good Tunnel

Bad Tunnel

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