Pinched nerve

Pinched nerve

Cervical Radiculopathy Pinched Nerve

Neck pain has many causes. Mechanical neck pain comes from injury or inflammation in the soft tissues of the neck. This is much different and less concerning than symptoms that come from pressure on the nerve roots as they exit the spinal column. People sometimes refer to this problem as a pinched nerve. Health care providers call it cervical radiculopathy.

The spine is made of a column of bones. A round block of bone, called a vertebral body, forms each bone, or vertebra. A bony ring attaches to the back of the vertebral body. When the vertebra bones are stacked on top of each other, the bony rings forms a long bony tube that surrounds and protects the spinal cord as it passes through the spine.

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Pinched nerve

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Symptoms

The symptoms from cervical radiculopathy are from pressure on an irritated nerve. These symptoms are not the same as those that come from mechanical neck pain. Mechanical neck pain usually starts in the neck and may spread to include the upper back or shoulder. It rarely extends below the shoulder. Headaches are also a common complaint of both radiculopathy and mechanical neck pain.

The pain from cervical radiculopathy usually spreads further down the arm than mechanical neck pain. And unlike mechanical pain, radiculopathy also usually involves other changes in how the nerves work such as numbness, tingling, and weakness in the muscles of the shoulder, arm, or hand. With cervical radiculopathy, the reflexes in the muscles of the upper arm are usually affected. This is why doctors check reflexes when people have symptoms of cervical radiculopathy.

Diagnosis

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Treatment

Nonsurgical Treatment Unless the nerve problem is getting worse rapidly, most doctors will begin with nonsurgical treatments.

At first, your doctor may prescribe immobilization of the neck. Keeping the neck still for a short time can calm inflammation and pain. This might include one to two days of bed rest and the use of a soft collar neck. This collar is a padded ring that wraps around the neck and is held in place by a Velcro strap. Normally, a patient need only wear a collar for one to two weeks. Wearing it longer tends to weaken the neck muscles.

Doctors prescribe certain types of medication for patients with cervical radiculopathy. Severe symptoms may be treated with narcotic drugs, such as codeine or morphine. But these drugs should only be used for the first few days or weeks after problems with radiculopathy start because they are addictive when used too much or improperly. Muscle relaxants may be prescribed to calm neck muscles that are in spasm. You may be prescribed anti-inflammatory medications such as aspirin or ibuprofen.

Some doctors have their patients work with a physical therapist. At first, treatments are used to ease pain and inflammation.

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Electrical stimulation treatments can help calm muscle spasm and pain. Traction is a way to gently stretch the joints and muscles of the neck. It can be done using a machine with a special head halter or the therapist can apply the traction pull by hand.

Some patients are given epidural steroid injections (ESI). The spinal cord travels within “a tube” along the bones of the spinal canal. The spinal cord is cwraped around by a rather tough sheet called dura. The space between the dura and the spinal column is the epidural space. It is thought that injecting steroid medication into this space fights inflammation around the nerves, the discs, and the facet joints. In some cases, the steroid injection is given around one specific nerve. This is called a selective nerve block. The response to this treatment helps confirm which nerve root is causing the symptoms.

Doctors usually have their patients try nonoperative treatments for at least three months before considering surgery. But when patients simply aren't getting better, or if the problem is becoming more severe, surgery may be suggested.

Surgery Most people with cervical radiculopathy get better without surgery. In rare cases, people don't get relief with nonsurgical treatments. They may require surgery. There are several types of surgery for cervical radiculopathy. These include: - Foraminotomy - Discectomy - Fusion

ForaminotomyAforaminotomy is done to open the neural foramen and relieve pressure on the spinal nerve root. A foraminotomy may be done because of bone spurs or inflammation.

DiscectomyIn a discectomy, the surgeon removes the disc where it is pressing against a nerve. Surgeons usually perform this surgery from the front (anterior)of the neck. This procedure is called anterior cervical discectomy.  In most patients, discectomy is done together with a procedure called cervical fusion, which is described next.

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FusionA fusion surgery joins two or more bones into one solid bone. The purpose for treating cervical radiculopathy with fusion is to increase the space between the vertebrae, taking pressure off the nerve. The surgery is most often done through the front of the neck. After taking out the disc (discectomy), the disc space is filled in with a small block of bone graft.  The bone is allowed to heal, fusing the two vertebrae into one solid bone. The space between the vertebrae is propped and held open by the bone graft, which enlarges the neural foramina, taking pressure off the nerve roots.

Rehabilitation

Nonsurgical Rehabilitation Even if you don't need surgery, your doctor may recommend that you work with a physical therapist. Patients are normally seen a few times each week for one to two months. In severe cases, patients may need a few additional weeks of care.

Your therapist creates a program to help you regain neck and arm function. Treatments for cervical radiculopathy often include neck traction, described earlier. Though neck traction is often done in the clinic, your therapist may give you a traction device to use at home.

It is very important to improve the strength and coordination in the neck and shoulder blade muscles. Your therapist can also evaluate your workstation or the way you use your body when you do your activities and suggest changes to avoid further problems.

After Surgery Rehab Rehabilitation after surgery for cervical radiculopathy can be a slow process. You will probably need to attend physical therapy sessions for six to eight weeks, and you should expect full recovery to take up to four months.

During physical therapy after surgery, your therapist may use treatments such as heat or ice, electrical stimulation, massage, and ultrasound to help calm pain and muscle spasm. Then you begin learning how to move safely with the least strain on the healing neck.

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As the rehabilitation program evolves, you will do more challenging exercises. The goal is to safely advance your strength and function. As your therapy sessions come to an end, your therapist will help you with decisions about getting you back to work. Your therapist can do a work assessment to make sure you'll be able to do your job safely. Your therapist may suggest changes that could help you work safely, with less chance of reinjuring your neck.

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