What is a Pinched Nerve?

How is a Pinched Nerve Diagnosed?

Accurate and thorough diagnosis is key to selecting the best treatment options. The following is part of a comprehensive diagnostic workup:

• Medical History Inventory of symptoms, previous treatments and medical care.
• Physical Examination A careful examination by a spine specialist for limitations of movement, problems with balance, and pain. The examination should also cover loss of reflexes in your extremities, muscle weakness, loss of sensation or signs of spinal cord damage.
• Diagnostic Tests Generally, plain x-ray films are taken which allows the physician to rule out other problems such as infections, fractures and instability. CT scans and MRIs are often used to give them a three-dimensional view of the lumbar spine focusing on soft tissues such as spinal disc, nerves and ligaments.

Non-Operative Treatment

Conservative treatment such as rest, physical therapy, Chiropractic care, and non-steroidal anti-inflammatory drugs (NSAIDs) are first choice for physicians. Rest and modification of activities can greatly benefit most patients.

• Pain Medications Anti-inflammatories, muscle relaxers and on rare occasions narcotic painkillers
• Alternating Heat/cold Therapy during the first 24-48 hours
• Physical Therapy exercises to include stretching, massage, strengthening educational patient resources
• Chiropractic Care Readjusting the spine facet joints
• Epidural steroid injections: are used two-fold, first, to relieve inflammation of the affected spinal nerve and secondly, diagnostically to confirm the correct affected level at which the pain originates from.

Least Invasive Endoscopic Procedure Options for Pinched Nerves

If pain still persists and patient is intolerant to the pain after non-surgical treatment and there is evidence by CT Scan, MRI or X-ray of neurological deficit, then surgical intervention is usually recommended. The following surgical options can treat bulging disc and pinched nerves with 90% success:

• Endoscopic Discectomy (transforaminal or interlaminer) With an incision less than a 1/2 inch. The surgeon can avoid all lamina bone resection and enter the spinal canal without disturbing or cutting muscle. The surgeon directly observes the herniated disc in a water (arthroscopy) environment with a surgical working channel endoscope coupled with a HD camera. Recovery is superior to microdiscectomy with most patients returning to work within a week. Conscious sedation is used with the patient awake, comfortable and aware during the procedure.
• Endoscopic Foraminalplasty is a ultra-minimally invasive procedure designed to relieve nerve compression caused by narrowing of the spinal foramina. Using a small endoscope, surgeons remove bone or tissue pressing on the nerves, alleviating pain, numbness, and weakness in the limbs. This procedure aims to restore function, improve mobility, and provide long-term relief for conditions such as foraminal stenosis, herniated discs, and degenerative disc disease.

Minimally Invasive Surgery Options For A Pinched Nerve

• MIS Laminectomy Some or all of the lamina, or posterior part of the vertebra and spinal ligament are removed to free the nerves. Sometimes a spinal fusion is incorporated with a laminectomy due to spinal instability.
• Foraminotomy The foramen or openings on the sides of the vertebra, through which spinal nerves exit the spinal column, is removed to reduce pressure on the nerve. Sometimes a spinal fusion is incorporated due to spinal instability after decompressing of the foramen.
• MIS Microdiscectomy Is a surgery to remove herniated disc material that is compressing a nerve root or the spinal cord. This surgery is usually done as a microdiscectomy using a microscope or surgical loupes. Before the discectomy is done the surgeon removes a small piece of bone called the lamina from the targeted intervertebral body in order to access the herniated disc. This bone resection is referred to as a laminectomy or laminotomy. A microdiscectomy can be done as an open or with a tubular retractor.
• MIS TLIF Spinal Fusion Two or more vertebrae are immobilized with surgical rods and screws. The spinal disc is decompressed and removed. Bone graft is placed in the disc space between the vertebrae to encourage growth of the bones together.

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