- Decompression of nerve roots
- Decompression of the spinal cord or cauda equina
- What are the Symptoms of Nerve Root Compression?
- What Causes Nerve Root Compression?
- How is Root Nerve Compression Diagnosed?
- How is Spinal Cord Compression Treated?
- How Can I Prevent Root Nerve Compression?
- Physiotherapy treatment for acute nerve root compression.
- Can Nerve Root Pain of the Neck cause any long-term effects?
- Examining a nerve compression
- Cranial nerve roots
- Could there be any long-term effects from acute nerve root compression?
- Physiotherapy for nerve root pain in the neck
- Symptoms of a nerve root compression in the neck
- Surgery of nerve root compressions
- What causes nerve root pain in the neck?
- Signs and symptoms
- What are symptoms of nerve root pain of the neck?
- What are the symptoms of acute nerve root compression?
- What shouldn’t I do if I have acute nerve root compression?
- Spinal nerve roots
- What should I do if I have acute nerve root compression?
- Symptoms of nerve root compression
- Degeneration of the nerve root canal
- Lower limb radiculopathies
- A herniated disc as a cause of nerve compression
- Pain and pathologies
- Upper limb
- Lower limb, abdomen and pelvis
Spinal decompression is the procedure which reduces pressure on the spinal cord.
Acute nerve root compression is when a nerve is compressed by a structure within the back as it leaves the spinal column. Physiotherapy is a very effective treatment for acute nerve root compression.
Above: Rolling Soft Tissue Massage applied to the lower back by experienced therapist
Acute nerve root pain of the neck occurs when a nerve coming from the spinal cord gets compressed. Compression of a nerve in the neck commonly causes referred pain in the arm. Physiotherapy is an excellent way to treat acute nerve root pain of the neck.
Above: Mobilisations of the cervical vertebrea to relieve nerve impingement
Decompression of nerve roots
When a single spinal nerve root is compressed, the resulting clinical outcome is termed radiculopathy, and is usually labeled according to the specific nerve root compressed (hence compression of the nerve root exiting the spinal column below the left-sided pedicle of the L5 vertebra will be diagnosed as «left L5 radiculopathy»).
Decompression of the spinal cord or cauda equina
A nerve root (Latin: radix nervi) is the initial segment of a nerve leaving the central nervous system. Nerve roots can be classified as:
- Cranial nerve roots: the initial or proximal segment of one of the twelve pairs of cranial nerves leaving the central nervous system from the brain stem or the highest levels of the spinal cord.
- Spinal nerve roots: the initial or proximal segment of one of the 31 pairs of spinal nerves leaving the central nervous system from the spinal cord. Each spinal nerve is formed by the union of a sensory dorsal root and a motor ventral root,[1] meaning that there are 62 dorsal/ventral root pairs, and therefore 124 nerve roots in total, each of which stems from a bundle of nerve rootlets (or root filaments).
About every third of over 30-year-old people have neck and shoulder region pains and even 80% have back pains at some point in their life. Pains fixated only in the neck or back usually can’t be treated surgically. If radiating pain to the limbs, tingling or numbing also occur, a nerve root compression may be in question.
With some nerve root compressions, surgery results in a very good outcome. Most typical patients like this are patients suffering from nerve root or spinal cord compressions in the lumbar spine or in the cervical vertebrae. The problems of these patients can be well handled and treated at the private practitioner’s reception as well. Also, it is possible to perform a surgery in privately owned Mehiläinen.
- Blumenfeld, Hal (2010). Neuroanatomy Through Clinical Cases (2nd ed.). Sunderland: Sinauer Associates. p. 321. ISBN 978-0-87893-058-6.
- Sanders, K. (2019, March 30). Summary of the Cranial Nerves. Teach Me Anatomy. https://teachmeanatomy.info/head/cranial-nerves/summary/
- Hagan, Catherine (2012). Comparative Anatomy and Histology. Academic Press: Piper M. Treuting, Suzanne M. Dintzis. ISBN 9780123813619.
- Biga, L., Dawson, S., Harwell, A., Hopkins, R., Kaufmann, J., LeMaster, M., . . . Runyeon, J. (unk). 13.3 Spinal and Cranial Nerves. Retrieved November 20, 2020, from https://open.oregonstate.education/aandp/chapter/13-3-spinal-and-cranial-nerves/
- «A Neurosurgeon’s Overview of the Anatomy of the Spine and Peripheral Nervous System». www.aans.org. Retrieved .
- Spinal Stenosis~treatment at eMedicine
- Weinstein, James N.; Tosteson, Tor D.; Lurie, Jon D.; Tosteson, Anna N.A.; Blood, Emily; Hanscom, Brett; Herkowitz, Harry; Cammisa, Frank; Albert, Todd; Boden, Scott D.; Hilibrand, Alan; Goldberg, Harley; Berven, Sigurd; An, Howard (2008). «Surgical versus Nonsurgical Therapy for Lumbar Spinal Stenosis». The New England Journal of Medicine. 358 (8): 794–810. doi:10.1056/NEJMoa0707136. PMC . PMID 18287602.
- Daniel, DM (18 May 2007). «Non-surgical spinal decompression therapy: does the scientific literature support efficacy claims made in the advertising media?». Chiropractic & Osteopathy. 15: 7. doi:10.1186/1746-1340-15-7. PMC . PMID 17511872.
- Singh, V; Malik, M; Kaur, J; Kulandaivelan, S; Punia, S (March 2021). «A systematic review and meta-analysis on the efficacy of physiotherapy intervention in management of lumbar prolapsed intervertebral disc». International Journal of Health Sciences. 15 (2): 49–57. PMC . PMID 33708044.
- Resolution limitations: Small nerves are fairly resistant to imaging and even structures like the sacrococcygeal plexus can’t be seen with MR tractography.
- Dynamic nature of entrapment: Nerve entrapment can be dynamic where the symptoms can only be elicited with certain movements. MR imaging is done while the patient is lying still and may not be able to reproduce the conditions of entrapment.
- Focus on structural abnormalities: Nerve entrapment can sometimes result from problems that don’t cause visual changes, such as inflammation or the tightness of surrounding tissues.
- Positional limitations: MRIs are done with the patient lying down. The geometry of the machine does not provide room for the patient to sit or stand during the scan where the symptoms may be reproducible. While sitting and standing MRIs exist, the resolution provided is significantly lower (0.6T vs 3.0T).
- Poor visibility of entrapping tissue types: MR visualizes soft tissue according to water content. Tissue types with low water content such as fibrotic tissue are resistant to imaging and yet may be highly clinically significant.
The major limitation of extra-operative electrophysiology studies is that they do not have direct access to the nerve. In contrast, intra-operative electrophysiology studies can be done with direct access to the nerve, and this is a useful tool for nerve decompression surgery. During surgery the studies can be used to identify which nerves innervate given myotomes, identify which blood vessels are essential for a nerve, and to compare nerve conduction before and after decompression.
Root nerves are cables that exit the vertebral canal branching out from the spinal cord, at each level of our spine carrying signals in and out of the brain. Compression is caused by any condition that puts undue pressure on these structures, most frequently discal protrusion. This situation frequently develops in the cervical and lumbar parts of the spine, which are the most mobile, causing pain in the neck or the low back.
What are the Symptoms of Nerve Root Compression?
Depending on the cause of compression, symptoms may develop quickly or slowly. They differ based on the level and severity of compression.
- Pain and stiffness in the neck or lower back
- Burning pain that spreads to the arms, buttocks, or down into the legs (AKA sciatica)
- Numbness, cramping, or weakness in the arms, hands, or legs
- Loss of sensation and weakness in the feet
- Trouble with hand or leg coordination
- Pressure on nerves in the lumbar region (lower back) can cause emergency symptoms like loss of bowel or bladder control, severe numbness in the thighs and legs, severe pain, and weakness in the legs
What Causes Nerve Root Compression?
The most common causes of nerve root compression include:
- Gradual wear and tear of the disc
- Gradual wear and tear on the bones of the spine/osteoarthritis
- Injury to the spine
Cancerous and noncancerous tumors - Infection
How is Root Nerve Compression Diagnosed?
Spinal cord compression can be diagnosed by:
- X-rays of your spine
- CT scan or MRI
- Bone scan
- CT scan is taken after injecting dye into the spinal column (myelogram)
- Electromyography (EMG), an electrical test of muscle activity
How is Spinal Cord Compression Treated?
- Anti-inflammatory medications may help decrease swelling and reduce pain
- Epidural steroid injections into the spinal area
- Physiotherapy, which can help to strengthen the related muscles
- If compression is due to a tumor, radiation therapy or chemotherapy may be used
- Your doctor may suggest surgical treatment if any of the conservative treatments do not work
- Vertebrae fusion/bone fusion
- Removal of compression (disc, bone spurs, bone fragments, etc.)
- Widening the space between the vertebrae using a spacer
How Can I Prevent Root Nerve Compression?
- Regular exercise
- Maintain good posture
- Proper posture while lifting heavy objects
- Using a good chair that supports the natural curves of your back while sitting.
- Maintain a healthy weight
- Do not lift heavy weight with your back muscles only
Disc herniations in the neck or back may result from trauma, such as a car accident, or from underlying degenerative disc disease. Most disc herniations cause pain and require treatment. In meeting with clients about the consequences of disc herniation, attorneys must keep in mind that some herniations are far more serious than others. One consequence of this is that a physician who meets a patient with signs and symptoms of spinal nerve root compression is obligated to listen carefully to the history and take steps to diagnose and treat the problem before serious, permanent deficits become unavoidable.
Herniated Discs
The discs between our vertebrae are comprised of a semi-solid gelatinous central portion (the nucleus pulposus) and a tougher fibrous outer layer (the annulus fibrosis). The discs are near nerve roots that exit the spinal cord and enervate various parts of the body. With aging and/or trauma, the annulus can rupture, allowing the nucleus pulposus to protrude. This condition is known as a disc herniation. When disc herniation occurs, it can compress and damage the nerve roots. The posterior portion of the discs in the lumbar spine are reinforced by the posterior longitudinal ligament, which may compress posteriorly herniated nucleus pulposus against the lumbar nerve roots.
Nerve Root Compression
Herniated discs which compress nerve roots can cause profound neurologic damage, including severe motor and sensory loss. Nerve root compression results in distinctive signs and symptoms that can be traced to the intervertebral level of the compressed nerve root. Patients may report radiating pain, sensory loss and weakness, and may exhibit reduction in or loss of reflexes.
Nerve root compression can range from mild to severe. Mild nerve root compression may not require surgical treatment and may be appropriately treated with medications and other conservative measures. Nerve root compression that is severe enough to cause weakness in the arms or legs requires prompt diagnosis and surgical treatment because compression leads to death of the nerve cells and can permanently affect the function of the sensory and motor nerves downstream from the point of compression.
Left untreated, patients with cervical nerve root compression can lose function in an affected arm. With large disc herniations in the lumbar spine, several nerve roots can be affected. Bilateral radiating pain into the legs, extensive weakness and sensory loss, and a loss of bowel and bladder function is called cauda equina syndrome. Patients with cauda equina syndrome can suffer great loss of function, including the ability to walk, to urinate, to defecate normally, and the loss of genital sensation.
The physician must perform a full neurologic exam if the patient complains of weakness and sensory loss. The examination of the patient should include sensory, strength, and reflex testing to determine whether there is evidence of neurologic dysfunction. Consideration of cauda equina syndrome requires that the physician check for “saddle anesthesia” (loss of genital/rectal sensation) and rectal sphincter muscle function. If the patient has acute radiculopathy with rapidly progressive neurologic deficits or radiculopathy with urinary retention, saddle anesthesia, or bilateral neurologic symptoms, then Magnetic Resonance Imaging (MRI) studies should be performed urgently. MRI studies are the best means of confirming when a patient has suffered a disc herniation that is causing compression.
We have represented numerous clients in cases where providers failed to diagnose and obtain treatment for such patients. Often they fail to properly listen to or examine the patient. It is surprisingly common for providers to fail to recognize the urgency of the patient’s condition and fail to obtain appropriate testing and treatment.
Medical Standards of Care–Treatment
Compression that results in serious neurologic signs and symptoms must be corrected surgically. It is generally accepted in medicine that the sooner the decompression occurs the better. The severity and duration of neurologic signs and symptoms as of the time of surgery are good predictors of what the patient’s recovery will be after surgery. If the compression is severe and left untreated for days or weeks, then the patient may have little or no recovery after surgery. If the compression is corrected quickly, before profound weakness occurs, then the patient may recover to normal or near-normal function.
In particular, the loss of bladder function in cauda equina syndrome has been well-studied. Multiple studies have demonstrated that when surgical decompression occurs within 36 hours of the onset of urinary retention, patients have a much better chance to recover bladder function. Late decompression may mean that the patient permanently loses function and will face a lifetime of catheterization.
Our firm has successfully handled many medical malpractice cases where medical care providers failed to diagnose acute nerve root compression leading to progressive loss of neurologic function. These cases require working with multiple expert witnesses to prove not only that the diagnosis should have been reached, or reached earlier, but also that earlier treatment would have allowed the patient to obtain a significantly better recovery of function. Our attorneys are always available to evaluate potential medical negligence cases.
Physiotherapy treatment for acute nerve root compression.
Above: Mobilisations of the vertebrea in the lower back by experienced therapist
Can Nerve Root Pain of the Neck cause any long-term effects?
As long as it is properly diagnosed and appropriately treated with the correct physiotherapy acute nerve root pain does not usually produce any long-term effects. Recovery usually takes place in a matter of weeks. However, in some serious cases, or those managed incorrectly recovery may take much longer.
Above: Experienced Physiotherapist conducting an assessment of the cervical spine, muscles and connective tissues in the neck
Please call Physio.co.uk today on 0330 088 7800 or book online to arrange an appointment.
Examining a nerve compression
The identification of nerve root compression states starts with carefully examining the patient. If the examination raises a suspicion of a compression state, the right diagnosis can be gotten with an MRI scan of the cervical spine. Sometimes, an electromyoneurography (EMNG) test performed by a clinical neurophysiologist may be needed along with the MRI scans, especially if the MRI scan shows changes in many levels and the level causing the symptoms needs to be confirmed. At times, a regular X-ray is needed to check the condition of the bone structures.
Some of the patients at the neurosurgeon’s reception have already been thoroughly examined by other doctors, such as neurologists or physicians and the neurosurgeon is asked for an opinion about a possible surgery. On the other hand, it is also possible to come to a neurosurgeon’s consultation in an earlier stage to ponder about whether radiating pains in the legs or arms are due to a nerve compression.
Cranial nerve roots
Could there be any long-term effects from acute nerve root compression?
Acute nerve root compression does not usually cause long-term effects, if it is appropriately diagnosed and treated. A full recovery is usually within a couple of months. However, dependent on the size of the disc bulge and the extent of nerve compression, this period may be prolonged. If the disc bulge is extremely large and causing severe symptoms, it may be necessary to undergo surgery to release the pressure on the nerve. This will increase your recovery time.
Above: Soft tissue massage of the lower back muscles and connective tissue by specialist therapist
To arrange a physiotherapy assessment with a spinal specialist call Physio.co.uk on 0330 088 7800 or book online.
Physiotherapy for nerve root pain in the neck
The assistance of a physiotherapist is very important in the treatment of acute nerve root pain. Physio.co.uk will diagnose your problem and determine its severity. This will enable your physiotherapist to design you an appropriate treatment plan. This may initially involve techniques to reduce your pain. Other treatments may include:
- Electrotherapy
- Manipulation / Mobilisation
- Exercise Programmes
- Massage
- Ergonomic Assessment
- Proprioceptive Exercise
To arrange a physiotherapy neck assessment call Physio.co.uk on 0330 088 7800 or book online.
Symptoms of a nerve root compression in the neck
- radiating pain, for example to the upper arm or the thumb becoming numb
- weakening strength
- aches between shoulder blades
- in certain head positions the aches in the arm may ease
- aches or numbing in the arm, which wake you up during the night
- pain killers aren’t much help
Surgery of nerve root compressions
A decompression surgery for the compressed nerve roots performed by a neurosurgeon is now-days done with the help of a microscope. In the surgery, a disc or a bone spur, which is compressing the nerve root is removed. The surgery doesn’t interfere with the nerve root or the spinal cord. The correctly selected surgical treatments for nerve root compressions will help the patient significantly. Especially the pain symptom often eases fast. A lot of the times, the patient will tell about the pain being left behind on the operating table. However, the weakening strength or permanent numbing caused by the nerve root compression go away more slowly. These symptoms indicate, that there has been a prolonged or a strong compression state on the nerve root. At times, especially after continuing for months, these symptoms won’t be healed despite the nerve root’s successful decompression surgery.
Most of the surgeries done in the cervical spine area are done from the front of the neck, where the distance to the spinal disc area is the shortest. Only some of the cervical spinal stenosis are cut through the back of the neck, while all herniating discs in the lower back are cut through the back. After a herniating disc surgery, the patient is usually monitored for one night and can then go home the next day. The recovery time is about one month depending on the patient’s job. After the recovery time the patient can usually go fully back to work, as well as hobbies.
What causes nerve root pain in the neck?
The most common neck injuries the physiotherapists at Physio.co.uk see are:
- Irritation of discs in the neck
- The presence of osteophytes (bony outgrowths)
- Inflammation of the structures in the neck
Above: Passive stretch of the muscles and connective tissues in the neck
All these cause the nerves to be compressed as they exit the spinal column.
Signs and symptoms
The distribution of symptoms is highly specific to the nerve entrapped and the way the nerve courses and branches beyond the entrapment point. For a given entrapment neuropathy, symptoms will only present in the areas innervated by that nerve and distal to the entrapment point. The symptom distribution is highly dependent on a patient’s neuroanatomy, which may mean that two patients can present differently despite having the same nerve entrapped.
What are symptoms of nerve root pain of the neck?
Above: Soft tissue massage of the muscle and connective tissues in the neck to relieve pain and aching
What are the symptoms of acute nerve root compression?
Acute nerve root compression causes a sudden onset of pain in the leg (known as sciatica). This pain is commonly described as a shooting, burning or intense aching pain that is difficult to locate. You may also be unable to stand up straight. Pain is often worse when sitting, bending, lifting, coughing or sneezing. Weakness, numbness, and/or pins and needles can also be caused in the hip, knee, calf, ankle and/or foot. Other symptoms may include:
Above: Rolling Soft Tissue Massage applied to the lower back by experienced therapist
What shouldn’t I do if I have acute nerve root compression?
If you have or suspect you have an acute nerve root compression, you should not ignore the problem and continue to participate in sport or activities that aggravate your pain. Continuing could lead to your problem worsening and may prolong your recovery.
Spinal nerve roots
What should I do if I have acute nerve root compression?
If you have or suspect you have an acute nerve root compression, you should consult a physiotherapist immediately.
If you have pain in both of your legs, loss of muscle power in both of your legs, numbness in the saddle region, have difficulty passing water or passing stools you should go to your nearest accident emergency department immediately.
Symptoms of nerve root compression
The reason for the nerve root compression may be the narrowing of the nerve root canal caused by a herniated disc or degenerating bones. With a herniated disc the symptom may have started suddenly during the last few days. A nerve root compression caused by degenerating bones on the other hand may have had symptoms for even years.
In both cases the symptoms are however similar: The compression of the nerve typically causes pain, at times also numbing or weakening strength on the ending of the nerve in question. The worst symptom is usually concentrated quite accurately in the area of one nerve root level. For example, a bulging disc between the fifth and sixth vertebra in the cervical spine typically causes radiating pain through the upper- and forearm all the way to the thumb and index finger area. A herniated disc in the lower back typically radiates pain along the sciatic nerve through the thigh and outer area of the calf to the toes.
Degeneration of the nerve root canal
A nerve root compression in the cervical spine may have been causing worsening symptoms for even years, when the reason for it is the narrowing of the nerve root canal, lateral stenosis, due to degeneration of the bones. It is not rare, that the patient has had shoulder aches at the start, which has been examined and possibly treated as shoulder related problems. On the other hand, the patient’s symptom may have been interpreted as a ’tennis elbow’. Only after the treatments turn out to be ineffective, may the thought go to the cervical spine and nerve root compression.
Lower limb radiculopathies
The cause is a herniated intervertebral disc, often on a single nerve root. The first sign of the nerve root sickness is usually lumbago, which usually occurs with periods of remission. The time to develop a full radicular syndrome may take several months or several years. Pain generally increases gradually, but it can also be sudden. Cold causes muscle contraction, which leads to increased previously hidden symptoms.
- Scoliosis
- Paraspinal muscle contracture
- The reduction of lumbar lordosis
- Tingling or numbness
- Increased sensitivity
- Other inflammatory diseases
- Pain located on the front of the thigh and shin further radiates towards the inner ankle, sometimes the medial toe
- Occasionally, failure of the quadriceps muscle and reflex weakness
- Pain radiates to the side of the thigh and lower leg towards the back of the foot and toes 1–3
- All reflexes are preserved
- Pain radiates to the posterior side of the thigh and lower leg to the ankle side, sometimes up to the fourth toe
- Gluteal muscles are weakened
- Difficulty standing on toes
Treatment can vary based on the nature and severity of the disease. A compressed nerve root can cause radicular pain with or without radiculopathy. Most of the time, symptoms from a compressed nerve will start to feel better within 6 to 12 weeks of nonsurgical treatment.
A herniated disc as a cause of nerve compression
The cause of a nerve compression can be a herniated disc, which makes it possible for the core mass of the soft spinal disk to get access to press down on the nerve root. The symptom starts suddenly after a couple of days.
Pain and pathologies
Damage to nerve roots can cause paresis and paralysis of the muscle innervated by the affected spinal nerve. It may also cause pain and numbness in the corresponding dermatome. A common cause of damage to the nerve roots is spine lesions, such as prolapse of the nucleus pulposus, spinal tuberculosis, cancer, inflammation, spinal tabs. Root pain syndromes, known colloquially as radiculitis and sciatica, are among the most common symptoms caused by damage to the nerve root. Radiculopathy is commonly called the «root». In addition to pain, nerve damage may lead to impaired muscle control. Typically, mechanical dysfunction is caused by pressure on the nerve root or shock, affecting both the lower limbs and arms’ roots.
The first sign of disease (sometimes preceding the occurrence of the radicular syndrome by up to a few years) is a sensation of pain in the neck and shoulder area. This pain often manifests due to hypothermia, poor posture or ergonomics during work or sleep, or sudden head movement. Team roots are localized mostly within the three lower cervical roots, namely C5, C6, and C7.
- Forced reflexive position of the spine
- Paraspinal muscle contracture
- Reduction of cervical lordosis
- Numerous painful points on the edges of the blade
- Pain at the back of the head slope
- Pain radiating to the upper chest and shoulder area
- The positive sign of nerve root tension in the upper limbs
- Weakness, especially with certain activities
- Sensation of pain along the lateral brachium of the affected side of the arm
- C5 innervated muscle weakness may be found (e.g., rhomboids and deltoids)
- Sensation of pain along the lateral antebrachium of the affected arm
- C6 innervated muscles are weak (e.g., forearm pronator and supinator and wrist extensors)
- Sensation of pain along with the middle finger of the affected arm
- C7 innervated muscles are weak (e.g., wrist flexors and finger extensors)
Treatment should be initiated as early as possible, before any muscle tone increases, which further intensifies the pain. Traction is recommended to decompress compressed roots. Radiculopathy can be caused by herniated nucleus pulposus. Surgery is the last resort when conservative therapy is unsuccessful.
