About pinched nerves and herniated disks—oh how that hurts!!!
Nitin K. Sethi, MD
Assistant Professor of Neurology
New York-Presbyterian Hospital
Weill Cornell Medical Center
New York, NY 10065
Recently I have seen many patients in my office with complaint of pain, numbness and tingling radiating down either the arms or legs. Most of these patients have pinched nerves due to herniated disks. They have ranged from ages of 25 to 65 and all of them have sought a neurological consultation primarily due to discomfort and pain from the pinched nerves.
I have written about pinched nerves before (we refer to this condition as radiculopathy. If the pinched nerve occurs in the neck i.e. the cervical vertebrae are involved it is called cervical radiculopathy and if it occurs in the lower back and involves the lumbar vertebrae it is called lumbar radiculopathy) but thought this might be a good time to again discuss this relatively common but frequently disabling condition. So what does a pinched nerve actually mean?
Well as you know our spinal cord is enclosed and protected by a rigid structure called the spinal column (commonly we refer to this as the spine. The spinal column is made of small bones called vertebra which are stacked one on top of each other and interconnected to one another by ligaments and other soft tissues. It is the tail (spine) of the vertebra which you can feel when you touch someone’s back. Now this bony spinal column encloses and protects the delicate spinal cord (the spinal cord starts from the base of the brain and contains all the nerve tracts which carry signals from the brain to the periphery of the body and vice versa. As it descends down into the neck, it gives off nerves which supply all the muscles of the arms and in the lower back (lumbar area) nerves to the legs come out from the spinal cord).
SO LET’S GO OVER THIS AGAIN. YOU HAVE THE SPINAL CORD; IT IS ENCLOSED BY A STRUCTURE (we are calling this the spinal column) WHICH IS MADE OF SMALL BONES CALLED VERTEBRA STACKED ONE ON TOP OF OTHER. FROM THE SPINAL CORD THE NERVES COMING OUT AND SUPPLY THE MUSCLES OF THE ARMS AND LEGS.
HOLD ON WE FORGOT ABOUT THE DISKS!!! So what is a disk or more correctly called the INTERVERTEBRAL DISK? As the name suggests the disk is a small cartilaginous tissue which lies in-between two vertebrae (think of it as a cushion between two bones which is what it actually is!!!). As compared to the vertebrae which are bones, the disk is a cartilage and fibrous tissue which is prone to degeneration and rupture.
Now imagine a scenario. You are lifting a heavy weight. You bend down, squat and strain to lift that heavy box of office supplies. You hear a “pop” in the back and feel “something give”. Well what do you think has happened? One of the cartilaginous disks in the lower back (most common is either the one between the 4th and 5th lumbar vertebrae or between the 5th lumbar and 1st sacral vertebrae. In the neck it is between the 5th and 6th or between the 6th and 7th cervical vertebrae) has herniated (POPPED OUT) and is now compressing (PINCHING) the nerve coming out of the spinal cord and going into the leg (may be the arm if it occurs in the neck). What is the end result of this disk herniation?
Well the next day you are in terrible pain and can barely get out of bed. You make an appointment to see your doctor. You have shooting pain (the pain radiates down your leg or in the case of a cervical disk herniation into your arm). You complain of feeling pins and needles and electric shocks radiating into your leg (or the arm as the case may be). Some people have more “negative” symptoms and complain of numb feeling rather than pain. The doctor examines you and orders a MRI of the lumbar spine (or the neck as the case may be). He gives you some pain medications and asks to take it easy!!!.
Voila you now officially have a herniated disk with a pinched nerve. It sure hurts like crazy. Will this story have a happy ending?
The story continues in the next post……….
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