Pinched Nerve Diagnosis & Treatments
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 – Assessment of symptoms, previous treatments and 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, we start with plain x-ray films, which allow us to rule out other problems such as infections. CT scans and MRIs are often used to give us three-dimensional views of the lumbar spine and can help detect herniated discs.
What are the Treatment Options for Pinched Nerves?
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.
- Medications: anti-inflammatories, muscle relaxers, and on rare occasions, narcotic medications
- Heat/cold therapy: during the first 24-48 hours
- Physical therapy: exercises to include: stretching, massage, and strengthening
- Chiropractic care: Readjusting the 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 ¼ 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 an 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: Unlike traditional open surgery, a small ¼ inch incision is made in the skin. The back muscles are spared and only dilated in order to gain access to the surgical site. The physician uses a working channel endoscope that allows for water and instruments to pass through the scope with an HD camera attached that provides a detailed view of the anatomy and the spinal cord. The patient is under conscious sedation- alert and comfortable throughout the procedure. No general anesthesia is needed and this lowers complication risk for the patient.
Minimally Invasive Spine Surgical Options For Pinched Nerves
- 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. Bone graft is placed in the space between the vertebrae to encourage growth of the bones together.
How Long Is The Recovery?
Our Least Invasive Procedure patients’ can begin getting out of bed one hour after surgery and go home shortly afterwards. There will probably be some pain after the procedure and is usually localized to the incision site. Activity is gradually increased and patients are typically able to return to work around a week to two weeks. Keep in mind just because there is less or no pain, always consult your physician before beginning any physical work.
Our Minimally Invasive Spine Surgery patients’ post-operative recovery is much longer and may involve overnight stay in the hospital. Once your pain in under control you can go home. Dr. Rodriguez will give you medication to control your pain while you recover at home.
At home, you will need to continue to rest. You will be instructed on how to gradually increase your activity. You may still need to take the pain medications for a while. However, pain and discomfort should begin to reduce within a couple of weeks after surgery. The doctor will discuss with you other techniques for reducing pain and increasing flexibility before you leave for home. The doctor will also discuss with you a time frame for when you can resume basic activities such as walking, driving and light lifting, and when you can return to more advanced activities such as physical labor, sports and yard work.