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.

When I Turn My Head I Get Pain in My Arm

In the neck we think of anterior column and posterior column issues. The anterior column is typified by the intervertebral disc, while the posterior column is typified by the facet joints. When you have pain that is not accompanied by weakness, then the pain is not likely to be caused by a bulging disc. Pain associated with weakness or weakness without pain implies that the disc is at fault. This is because in the cervical spine, the spinal nerve roots are distinctly motor nerve or sensory nerve roots. The anterior nerver roots are motor nerves and therefore are more likely to be impacted by a disc bulge or herniation, while the posterior nerve roots are sensory nerves in which case several factors might irritate them.



You can see in this illustration the difference between a disc herniation causing nerve root compression and a normal cervical relationship. Nerve root compression can involve sensory AND motor nerve compression, although it is possible to have pure motor nerve compression. In contrast, posterior column disorders typically produce only sensory changes. These could take the form of increased or decreased sensation as well as pain. Absent sensation implies a nerve root compression, while anything less than that suggests a nerve root irritation.

Got all that?

OK so you turn your head to the left and you feel a loss of sensation and pain in your arm and hand. You do not feel weakness, and you do not feel any numbness. When you turn your head away, it feels better. When you backward bend your head, it feels worse, forward bending feels better. Assuming all else is normal, this picture would lead me to believe that you have a posterior column problem with an irritated nerve root.

If I am correct, and again, I assume that you have had your health checked by your doc, you don't feel sick or nauseated and you are otherwise healthy - then you probably have an irritated facet joint at least. In any event, we need to provide a gaping drill to help you unload the structure.

Here is how you unload the RIGHT SIDE posterior column: Start by sitting on your right hand. Then

1. Forward bend your head to a natural stop.

2. Side bend your head to the left side until you encounter a natural stop

3. GENTLY rotate your head to the RIGHT again and again and again PAIN FREE

This should reduce your pain and give you relief by gaping and unloading the right side facet jionts.