pinched nerves
The nervous system is a highway system within our bodies that communicates signals from the body to the brain and vice versa. These signals include light touch, pressure, temperature and pain, as well as signals to move muscles. A common area where nerves are injured are when they exit the spinal cord in the neck or low back (mid back is less common). This condition, often called a pinched nerve, can lead to pain that travels down either the arm of leg. It can also lead to sensation changes such as numbness and tingling, as well as weakness. A patient can have one or all of these symptoms.
From a musculoskeletal standpoint, a pinched nerve is typically due to one of two causes, (1) a herniated disc or (2) arthritic changes to the spine. Discs are like jelly filled donuts that connect the vertebrae (bones of the spine). They provide stability and allow for range of motion in many directions. When a disc herniates, think of the jelly oozing out of the donut. Given the anatomy of our spine, the jelly usually oozes out in one particular direction (backwards) and then compresses the nerve, hence the term “pinched nerve” (see figure on the right). “Sciatica” is also used interchangeably when described a pinched nerve in the low back.
Arthritic changes to the spine can also cause a pinched nerve. Arthritis can be age related, and it becomes more prevalent as we get older. There is less cushion of the discs and bone spurs can develop. The areas around the nerves shrink. This narrowing of space is called stenosis. If severe enough, the nerves can become pinched.
The recovery of pinched nerves (medically coined radiculopathy) can occur via two means, by allowing the body to try and heal itself or by surgically removing the structure that is pinching the nerve. If a patient opts to treat the condition conservatively (non-surgically), one must understand that the recovery process can take some time (several months) and it is not a quick fix. There is evidence that if you are suffering from a herniated disc that it can shrink over time with corresponding relief of your symptoms.
The main goal of conservative treatment is to control/improve your pain and function, while allowing the body to heal itself, especially in the setting of a herniated disc. First line treatment usually consists of medications and physical therapy. Sometimes this works. Sometimes it doesn’t. We cannot predict your response to treatment. Epidural steroid injections can also be considered based on pain and/or function; keep in mind there are insurance requirements to determine if you qualify for an injection. Please refer to “Injections and Injection Info” under “Treatment” header.
If a patient fails conservative treatment, and/or if there is worsening weakness or numbness, surgery may then be the best option.