As a Spine Surgeon, I see people with pinched nerves almost everyday. Fortunately, most pinched nerves do not become a permanent problem. That is why greater than 98% of pinched nerves can be treated without an operation.
Pinched nerves are commonly caused by herniated nucleus pulposus (disk herniation), cervical and lumbar spondylosis (bone spurs). The more rare reasons include fracture, infection, tumor, and fat collection (epidural lipomatosis). For some, the pinching comes and goes secondary to loosening of the bones and shifting of the bones on one another (spondylolithesis). Fortunately, the great majority of the pinched nerves are from the disk herniation or bone spurs.
In the disk herniation, or bone spur situation, there is often a temporary, but significant pain response to the pinching. Like any tissue that is pinched, there is a swelling or inflammation process that paradoxically can increase the pain for a certain duration. Over time, the swelling goes away, and the nerve shrinks back to normal. That shrinking of the nerve is part of the “unpinching process”. Science can explain all these points in a most detailed and microscopic description. The simplest way is to say “the nerve swelling goes away, and nerve returns back to a normal size”.
In relationship to a disk herniation, Spine Surgeons now know that the larger disk herniations are often the ones that naturally shrink in size. The body actually considers the disk herniation as a foreign material, and attacks the disk fragment, and it does get degraded down in size. In addition, the larger disk herniations are often originally full of water. Over time, the water is absorbed, and the disk herniation fragment will dry up, thus further shrinking in size. This contributes to the “unpinching of the nerve”.
Bone spurs do not go away, and can and do grow in size. The nerve usually gets pinched secondary to a combination of the bone spur squeezing the nerve when the nerve is stretched or pulled. In the arm, the nerve bundles from the spine can be stretched when the arm is placed in the extremes of motion, or when the arm is being stressed by certain activities. Likewise, the nerves to the legs are also stretched when the leg is moved in a certain manner. There was a recent fascinating research performed looking at the location of the nerves in the spinal canal when the extremities are positioned in certain fashion. There was definite movement of the nerves within the spinal canal, depending on the position. If the nerve was then slightly pinched by a bone spur, it is not hard to understand how that movement will cause further pinching, and subsequent pain.
Even in the Bone spur scenario, the pinch is usually temporary, and the nerve recovers.
As a Spine Surgeon, I know most pinches do get better with time, activities modifications, and medications. Occasionally, steriod injections on the nerves are also required to help decrease the inflammation. While the initial pain can be severe, there is a good chance that the pinched nerve pain will be a temporary situation. Unfortunately, some pinches caused by fractures, tumors, infections, hematoma’s etc may require urgent surgical care to prevent a permanent situation. Thank goodness, that situation is less common.
If you have a severe pinched nerve, there is still a good possibility that may be only a temporary problem. At the same time, a Spine Specialist will be the best Physician to determine the best treatment options. Sometimes Surgery is still a good choice, if the pinching is severe, and prolonged.
- AANEM.. AANEM's top five choosing wisely recommendations. Muscle Nerve. 2015 Apr;51(4):617-9. PubMed PMID: 25789931