Manual A Simple Guide to Spinal Stenosis and Pinched Nerve (A Simple Guide to Medical Conditions)

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Conditions

If you have pain with certain movements, it may help with the diagnosis. These tests let your healthcare provider see the structures in your neck or back. Your healthcare provider may also inject a contrast material a dye into your spinal canal to help show the problem area. Medicine such as nonsteroidal anti-inflammatory drugs NSAIDs , narcotic medicines for more severe pain, and muscle relaxants. For a pinched nerve in the neck, wearing a soft collar around your neck for short amounts of time. Some people need more advanced treatments. Your healthcare provider might suggest injections of steroid medicine in the area where a disk is herniated.

Some people might benefit from surgery. During a surgical procedure called a discectomy, the surgeon removes all or part of the disk that is pressing on a nerve root. Along with this procedure, the surgeon may need to remove parts of some vertebrae or fuse vertebrae together. Staying physically fit may reduce your risk of having a pinched nerve.

Using good posture at work and in your leisure time, such as lifting heavy objects properly, may also help prevent this condition. If you sit at work for long periods, consider getting up and walking around regularly. A healthy lifestyle that includes not smoking and eating well may also reduce the risk for a pinched nerve. Medicines like nonsteroidal anti-inflammatory drugs NSAIDs , corticosteroids, or stronger narcotic medicines help reduce nerve swelling and relieve pain. Corticosteroids may also be given as an injection, which will also reduce inflammation and pain allowing the nerve to heal.

Losing weight, if needed, will help relieve pressure on the joints. Physical therapy may use specialized exercises to strengthen and stretch the back or neck muscles. A physical therapist may suggest wearing a soft collar or using traction to help the neck muscles rest and heal.

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Your healthcare provider may suggest a home exercise program that you can do on a routine basis. These measures also relieve pressure on the nerve. Your healthcare provider may be able to suggest self-care steps to help prevent or treat a pinched nerve. Sudden onset of numbness, weakness, or paralysis of an arm or leg that does not go away.

If symptoms of cervical myelopathy are evident or progressing, you ought to be assessed by your NASS doctor. In those patients where nonoperative measures are unsuccessful, surgical measures provide a good option. Your NASS doctor may recommend surgical intervention for cervical radiculopathy either through the front [anterior] or the back [posterior] of the neck, or both the front and back of your neck.

Several factors will be considered by your NASS doctor in choosing the type of surgery you undergo. These will include the exact location of any compression on your spinal cord or nerve branches, the number of levels at which there is compression, the overall alignment of your cervical spine and your overall medical condition. When surgery is carried out through the front of the neck, a small incision is made in the front of your neck.

The tissues are gently moved to the side and the cervical vertebrae easily accessed.

Radiculopathy | Johns Hopkins Medicine

The structures impinging on the nerve root are removed. Frequently a block of bone obtained from a bone bank or your pelvis will be inserted in the disc space and a metal plate and screws will be used to stabilize two vertebra. Anterior surgery may be required at more than one level and may require removal of the discs and the vertebrae.

Following surgery you may be in a neck brace for a short period of time depending on the surgical procedure.


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When surgery is carried out through the back [posterior] of the neck, a small incision is made directly over the area where the nerve branches off of the spinal cord. A high speed burr may be used to remove some of the bone spurs impinging on the nerve branch. Small disc fragments can be removed through this hole. Following surgery, a period of immobilization may be used. Posterior surgery can also involve a wider decompression of the entire cervical spinal cord through two operations: laminectomy and laminoplasty.

Nerve Root Block Injection Procedure Animation Video

In both of these operations, the pressure on the spinal cord is relieved by removing portions of the back of the vertebra. In laminectomy, the back of the vertebra is completely removed. In laminoplasty, a hinge is created on one side of the back of the vertebra and the lamina lifted up on this hinge to make room for the spinal cord.

Occasionally metal screws and plates are used following either of these operations to stabilize the cervical spinal column.

What are the symptoms?

If you have persistent pain, numbness or weakness in one of your arms that is not relieved following a short period of observation, you should certainly see your NASS doctor. Your NASS doctor will begin by letting you relate the history of how your symptoms began and how they progressed.

You will be asked a series of questions and a physical examination then carried out that is directed primarily at your neck, and nerve function in your arms and legs. Your NASS doctor will check your balance, test your gait. X-rays may be requested and will in some patients show signs of degenerative changes in the disc spaces or facet joints.

Magnetic resolution imaging [MRI] of the neck may be ordered. MRI pictures allow your NASS doctor to visualize structures that may be impinging on the spinal cord or the nerve branches. In some patients, injection of dye into the spinal cord [myelogram] may be required and this is followed by CT scans [computerized tomography]. Electrical testing of the nerves and spinal cord is requested in some patients.

Lumbar Spinal Stenosis

Because the nerve roots in this area of the spine primarily control sensations in your arms and hands, this is where the symptoms are most likely to occur. Thoracic radiculopathy refers to a compressed nerve root in the thoracic area of the spine, which is your upper back. This is the least common location for radiculopathy. The symptoms often follow a dermatomal distribution, and can cause pain and numbness that wraps around to the front of your body.

When a nerve root is compressed, it becomes inflamed. This results in several unpleasant symptoms that may include:. Sharp pain in the back, arms, legs or shoulders that may worsen with certain activities, even something as simple as coughing or sneezing. Your specific symptoms will depend on where in the spine the nerve root is pinched.

Radiculopathy is typically caused by changes in the tissues surrounding the nerve roots. These tissues include bones of the spinal vertebrae, tendons and intervertebral discs. When these tissues shift or change in size, they may narrow the spaces where the nerve roots travel inside the spine or exit the spine; these openings are called foramina. The narrowing of foramina is known as foraminal stenosis, which is very similar to spinal stenosis that affects the spinal cord.

In most cases, foraminal stenosis is caused by gradual degeneration of the spine that happens as you age. But it can also be a result of a spinal injury. One common cause of foraminal stenosis and radiculopathy is a bulging or herniated disc. Spinal discs act as cushions between your vertebrae.


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On occasion, these discs slip out of place or become damaged and press on nerves. This problem is most likely to occur in your lower back, but it can also affect your neck. Another possible cause of radiculopathy that may lead to narrowing of foramina is bone spurs — areas of extra bone growth.