WBulging Disc and Pinched Nerve
The spinal cord act as a communication carrier. It carries messages from the brain to the rest of the body and back too.
The spinal cord extends down the vertebra, with nerve cells branching out and connecting with the muscles everywhere in the body. Sometimes, these nerves become pinches, either because of bulging or herniated discs, or growths called bone spurs.
When this happens, your body sends pain signals to your brain. These signals should never be ignored. Damage occurring because of a compressed nerve can be minor but if proper treatment is not sought soon, it may progress into major damage and can result in temporary or even permanent health issues and pain. It is best to seek help from an experienced spine specialist as soon as you can in order to get your symptoms diagnosed properly and get started on an effective treatment plan.
In some cases, if a pinched nerve goes untreated for a long time, it may result in permanent damage such as sensation loss in the affected area or muscle weakness.
Causes of Pinched Nerves
Spinal and exiting nerves pass through narrow holes in the vertebral column, called the foramen. These nerves are the most vulnerable in your spinal canal. Sometimes, a tendon, disc or the surrounding bony structures can exert pressure on one of these nerves, ‘pinching’ them. This pinching often happens due to the degeneration of the spine over time, or in some cases, because of some physical trauma, like an injury or an accident.
There are some other activities that may also cause spinal or disc degeneration and lead to a compressed or pinched nerve such as maintaining a poor posture, lifting heavy objects improperly and repetitive motion.
When a nerve is compressed or becomes ‘pinched’, an inflammatory process starts immediately, resulting in pain in the neck or lumbar regions of the back.
Sometimes, this pain can spread and reach your shoulder and travel down the arm (cervical radiculopathy), or even radiate down the leg and cause a condition known as sciatica.
Age or physical trauma, like an accident, for example can cause the discs that lie between the vertebrae to become weak and develop cracks or tears. This causes the nucleus pulpous—the inner part of the disc—to push out through the annulus, which is the outer part of the disc outward, resulting in a bulging structure, called a bulging or herniated disc that exerts pressure on the spinal cord and may cause pain.
Symptoms of Pinched Nerves
A tingling sensation accompanies by numbness is often the most common symptom of a pinched nerve. Pain may accompany the tingling sensation and is often described as being “sharp” or “electrical”. Some patients experience a burning or tightness sensation in the affected area.
If the case is more severe, the pain and numbness can also be accompanied by muscle weakness. This happens when the nerves that control muscle function have been affected.
If this condition is not treated as soon as possible, these muscles may start to deteriorate in size, become weaker and lose their function.
If treatment for nerve compression is not started immediately, the damage can spread to the protected area around the nerve and cause swelling and scarring. This condition can result in peripheral neuropathy, carpal canal syndrome and excruciating pain in the arm.
- Medical history
Assessment of symptoms, previous treatments and care. - Physical examination
A careful examination by a spine specialist for limitations of movement, problems with balance, and pain. The examination should also cover loss of reflexes in your extremities, muscle weakness, loss of sensation or signs of spinal cord damage. - Diagnostic tests
Generally, we start with plain x-ray films, which allow us to rule out other problems such as infections. CT scans and MRIs are often used to give us three-dimensional views of the lumbar spine and can help detect Pinched Nerve.
Non-Surgical Treatment ?
- Alternating heat/cold therapy during the first 24-48 hours
- Pain medications
Anti-inflammatories, NSAIDS, muscle relaxers and on rare occasions narcotic painkillers - Physical therapy exercises to include: stretching, massage strengthening
- Epidural steroid injections are used two-fold, first, to relieve inflammation of the affected spinal nerve and secondly, diagnostically to confirm the correct affected level at which the pain originates from.
Surgical Treatment
If pain still persists and patient is intolerant to the pain after non-surgical treatment and there is evidence by CT Scan, MRI or X-ray or neurological deficit, then surgical intervention is usually recommended. The following surgical options can treat bulging disc and pinched nerves with 90% success:
- Microdiscectomy
Usually an open procedure or using tubular retractor with an incision of 1 inch. The surgeon usually observes through a microscope or set of eyeglass loops that helps magnify the anatomy. Recovery can be long and painful. Most of the pain post-operative is from the approach the surgeon made through major muscle support in your back. Anesthesia is necessary. - Laminectomy
During the microdiscectomy surgeons often have to resect the bone called the lamina in order to see the affected nerve and herniated disc. Recovery from microdiscectomy can be long and with bone resection adds to possible scarring in the area the surgeon is working. Anesthesia is necessary. - Spinal Fusion
A spinal fusion surgery is designed to stop the motion at a painful vertebral segment, which in turn should decrease pain generated from the joint. Spine fusion when indicated should be the last options offered. Sometimes when patients suffer from discogenic back pain, recurrent herniated disc and or instability and have failed less conservative surgical options, a spinal fusion may be indicated.
What Is The Recovery ?
Most patients can begin getting out of bed one hour after surgery and go home shortly afterward. Activity is gradually increased and patients are typically able to return to work within a few days. There will probably be some pain after the procedure and is usually localized to the incision site. However, always consult your physician before beginning any physical work.
Always seek your physician’s opinion when it is safe to return to work. Also, light administrative duty is recommended until your physician approves of any physical demands at your place of work.
At home, you will need to continue to rest. You will be instructed on how to gradually increase your activity. You may still need to take the pain medications for a while. However, pain and discomfort should begin to reduce within a couple of days after surgery. We will discuss with you other techniques for reducing pain and increasing flexibility before you leave for home. We will also discuss with you a time frame for when you can resume basic activities such as walking, driving and light lifting, and when you can return to more advanced activities such as physical labor, sports, and yard work.