Nerve Root Impingement: Causes, Symptoms, and Treatment Options

A certain degree of discomfort is expected when spinal nerve roots are impinged or irritated. Nerves transmit sensory information that drives body actions and senses. Increased sensitivity, numbness, and muscle weakness can occur when a nerve in the spine is injured. However, nerve root compression is never the direct source of back pain. Pain is often a resulting symptom of damage to the intervertebral disc such as herniated discs, bulging/slipped discs or degenerative disc disease. A nerve root can become inflamed or irritated due to biological reactions with substances released from a damaged disc, hence causing pain along the path of the nerve root.

Nerve root pain is usually classified according to the location of the affected nerve. There are two broad categories, namely

Lumbar nerve pain: Otherwise known as Sciatica, lumbar nerve pain is a combination of back and leg pain caused by nerve root inflammation in the lower back. The discomfort caused by lumbar nerve root inflammation is most severely felt in the section of the leg below the knee, including the feet and toes.

Brachial neuralgia: Brachial neuralgia develops in the nerves of the neck, which is also called the cervical spine. The pain can develop into Radiculopathy, where it radiates down the arm into the hands and fingers.

The spinal cord travels from the base of the brain until the L1 vertebrae in the lumbar spine. Each spinal segment has different nerve roots that run through the nerve canal or neuroforamen, with each nerve exiting from the spinal column at specific levels. There are 31 nerve roots attached to the spinal cord; 8 cervical nerves, 12 thoracic nerves, five lumbar nerves, five sacral nerves, and one coccygeal nerve.

A spinal nerve root is named according to its  location and position in the spinal canal. In the cervical spine, mainly the C2-C7 motion segment, the nerve root is named after the lower vertebrae. For instance, the nerve root present in the C6-C7 spine segment is called the C7 nerve root. In the lumbar spine, the opposite applies. The nerve is named from the top section between which it runs.

Severe conditions originating from nerve root compression are more likely to occur in the cervical spine than the lumbar spine. This is because the spinal cord runs through the cervical spine but stops in the upper lumbar spine and does not extend into the lower back. Instead it divides to form bundles of nerve roots known as the Cauda Equina.Therefore, nerves in the lumbar spine and sacral regions have more space and are less likely to be impinged or irritated.

Both general and specific factors can cause nerve root impingement. Known causes of nerve root impingement in the spinal canal include;

• Facet joint hypertrophy
• Bone spurs
• Herniated discs
• Spondylosis
• Spinal Abnormalities, such as tumors, cysts, hernias, and hematomas
• Injuries and  infections

The most common reason behind a nerve root becoming irritated is a herniated disc. A herniation is a phenomenon that occurs when there is an annular tear in the annulus fibrosus of an intervertebral disc. When this outer wall is ruptured, the jelly-like nucleus pulposus is squeezed into the nerve canal, where it might contact the nerve root. Once this contact is established, the nerve root becomes pinched.

Disc herniations in different segments of the back can lead to neural or nerve root impingement. Herniated discs in the cervical and lumbar spine impinge nerves exiting at a certain level, such as the C6 nerve root at C5-C6 cervical segment and the L5 nerve root at the L4-L5 segment.

Of all the spine segments, the thoracic spine is the least likely for disc herniations to occur because the spine is stabilized by the rib cage. The cervical and lumbar spine typically experience more ranges of motion than the upper back; therefore, discs in this segment are less likely to be damaged. 

Symptoms of nerve root impingement vary depending on the location and severity of the condition. As highlighted above, the neck and lower back are the two regions with the highest likelihood of developing nerve root impingement. Common patient complaints include pain, numbness, tingling and weakness

L5-S1 nerve impingement symptoms

Each spinal region has peculiar functionalities that create exceptional circumstances and hot spots for disc herniation and nerve impingement. A typical disc herniation is often observed in spinal segments that experience the highest range of motion and support the most significant body weight. Such a segment is the lumbosacral joint, otherwise known as the L5-S1 spinal segment.

L5-S1 is a crucial zone between the lower back and the pelvis where the spine transitions from lumbar to sacral. In this motion segment, natural spinal curvature goes from a forward bend into a backward curve. Load from the back is also transferred to the legs through this joint. Non-surprisingly the L5 and S1 nerves are two of the most pinched nerves in the lower back. 

Symptoms of L5 and S1 nerve impingement include;

• Weakness and numbness in the feet and toes
• Weakness in the back of the calf
• Loss of reflexes in the ankles
• Sciatica pain down the leg

C6-C7 Nerve impingement symptoms

In the neck, the C6-C7 motion segment acts as central support for the weight of the skull and the rest of the upper neck. It is also the most mobile segment in this zone and connects the cervical spine to the thoracic spine. Although herniation can also occur in the C4-C5 and C5-C6 segment, the C6-C7 is the second most prone to developing a herniated disc that can cause nerve impingement and inflammation. 

Symptoms of nerve impingement in the C6 and C7 nerve roots include;

• Weakness in the biceps and wrist extensors
• Numbness in the arms and fingers
• Loss of reflexes in the triceps 
• Pain shooting down the arm

The first step in diagnosing nerve root impingement is a thorough physical examination in addition to a critical evaluation of the patient’s medical history. The physician will also examine muscle reflexes, strength, and posture to detect any pain, weakness, or loss of sensation in the affected zones. 

Your doctor might also recommend some form of radiologic imaging tests such as an X-Ray, CAT, and MRI scan to detect any damage to spinal tissue, discs, ligaments, and bones. The results of these tests will dictate the most appropriate treatment method. The most sensitive test is an MRI scan. 

Nerves have a bias for taking a long time to mend. Nerves heal from the top down and depending on how much damage is done when the nerve impinges, the nerve may take weeks to months to fully repair. Nerves grow back at 1.4mm per day.

The goal of treatment for neural impingement is to decompress the nerve root and alleviate discomfort while allowing the nerve to recover independently. Inflammation of the nerve root is the main cause of associated pain, therefore treating the inflammation as well as eliminating its source can ease the pain.

The most common technique for treating nerve root impingement is through a spinal decompression procedure. This surgical technique aims to reduce pressure on the nerve root and give it more space to heal naturally. Patients have a wide array of surgeries to select from and should always consult their physician before deciding. Deuk Laser Disc Repair spine surgery has been medically approved as one of the safest procedures for treating spinal conditions caused by herniated discs. The procedure uses the least invasive technique with virtually no blood loss. Patients go home one hour after this FDA approved outpatient procedure and no opioids are needed for recovery.

Symptoms of nerve root inflammation, such as radiculopathy, are usually treatable with endoscopic procedures like the deuk laser disc repair. Two factors your physician will consider before prescribing medication are the severity of your condition and any underlying medical issues you might have. In appropriate cases, before trying surgery, doctors will typically recommend one of the following non-surgical treatments;

• oral corticosteroids or injectable steroids 
• non-steroidal medications such as ibuprofen, aspirin, or naproxen 
• narcotic pain relievers 

Another worthy recourse can be physical therapy, which includes techniques like using a soft cervical collar and the application of ice and heat.

Certain recognized risk factors can increase an individual’s likelihood of developing a pinched nerve. Studies have shown that men between the age of 20 and 50 are the most likely to suffer from spinal conditions like nerve root impingement. However, women and men of other ages are also at risk when appropriate lifestyle changes are not implemented. Disc traumatic injuries are the most common cause.

Individuals of all ages can avoid nerve root compression pain with the use of specific measures. These are some of them:

• Maintaining proper posture 
• Regular exercise, with incorporation of weight-bearing exercises
• Core strengthening exercises
• Keeping a healthy body weight
• Incorporating frequent pauses into a working schedule and including stretching into exercises.
• Keeping the neck straight while working or operating screens

At Deuk Spine Institute, we specialize in minimally invasive surgical techniques and comprehensive spine treatments to cure back and neck pain. Our world-class physicians are personally invested in the well-being of every patient. Start your treatment with us today by submitting your MRI online for a free remote review to determine your candidacy for surgery. You can also visit one of our locations in person by calling patient services at 321-255-6670.