Cervical Nerve Root Compression

Question: How do you know if you have nerver root compression from a herniated cervical disc?

Answer: You have pain AND weakness in the arm .


Click the "play" button to listen:

In the image adjacent, you can see how a cervical spine disc herniation compresses the anterior nerve root of the spinal nerve causing motor weakness. Because the disc is anterior to the spinal cord, and because the anterior nerve root is the motor nerve root, compression leads to weakness and this is always the first consideration when motor weakness is the primary sign along with pain as a symptom.

As in this image, the herniation might or might not be an indication for a cervical discectomy. The reality is that you should allow time to pass before committing to a surgical solution. The reason I say this is that the decision largely depends on what tissue is compressing the nerve root.

If the nucleus is the primary culprit, then allow time to pass because the nucleus is made up of glucosaminoglycans (GAG's) and GAG's decay fairly rapidly, which means that they biind less water. As they decay, they dehydrate, and as they dehydrate, the pressure comes off the nerver root, and strength should return.

On the other hand, if the material pressing against the nerve root is part of the fibrous shell of the disc - the Annulus, then surgery mught in fact be the best option. In this case, the Annulus does not decay, and it is sort of like the reality of having a pin stuck in your arm - it hurts till you take it out. But that said, cervical traction is a good idea to try. If traction is successful, great, if not, the next level of intervention worth trying is potentially selective injection techniques. Often, the combination of selective injections with cervical traction along with aerobic exercise and other gapping activities (to gap the cerival spine, forward bend, side bend the head away from the pain, and GENTLY rotate toward the pain) would offer the best course of action.

Acutely, the position of comfort is to place the same side forearm on the forehead to achieve temporary relief of pain.

So acutely try this:

• Aerobic exercise for a half hour to soften and relax the accessory muscles of respiration
  
• Gapping exercises to relieve the nerve root
• Cervical traction to relieve the pressure
• Forearm on the forehead to unload the tension on the nerve and reduce arm pain
• If all else fails, then see the doc for evaluation and consideration of a selective injection

There are a couple of excellent mechanical home traction units that we use. One, by EMPI, like this one that is recommended.

Depending on which side the herniated disc is affecting, you could position the head in alight side bending to further provide relief while under traction. It is key though, if you use this device, to allow your neck to relax before you pick up your head when you are done with the traction. as for how much traction, I suggest that the traction is pain free, but you should try to use at least 20# of traction for a few minutes when you do use the machine.