What Can Cause Nerve Root Irritation and How is it Treated?

Nerve root irritation is a condition in which any nerve arising from the spinal column gets irritated due to surrounding structures. The commonly affected areas are the neck and the back and the point of irritation is usually the region where it leaves the spine, where the nerve root is present. The nerve can also get irritated or entrapped on its course, but nerve root irritation is more concerned with irritation of the nerve at the nerve root.

There are many structures present around the spinal column and the commonest to get affected are the bony parts and soft tissues supporting the spine.

• Nerve Root Irritation Caused due to Injury or Trauma: Any injury, inflammation or damage to the surrounding joints, muscles, ligaments can lead to irritation of the nerve root. The commonest cause of nerve root irritation is muscular spasms or tensed muscles.
• Nerve Root Irritation Caused due to Spinal Disc Problems: Disc herniation or protrusion and disc degeneration in the cervical, lumbar or thoracic regions can cause impingement of nerves and nerve root irritation.
• Accumulation of fluid like swelling in the region, bleeding due to injury or other causes too can cause pressure on the nerve roots.
• Sometimes, certain growths like tumors or enlargement of structures and organs can cause compression of nerves at the roots leading to nerve root irritation.

Nerve root irritation commonly occurs in lower cervical segment (C5-C6 nerve root irritation) or in the lower back, at the lumbosacral joint (L5-S1 nerve root irritation). Common symptoms of nerve root irritation include radiating pain, rigidity in muscles, numb feeling and altered sensations.

1. Symptoms of Cervical Nerve Root Irritation – Cervical nerve root irritation occurs when the nerve roots in the cervical spine are irritated and often result in pain in arms, hands and fingers. Pain may be present in the neck, with difficulty in neck movements, depending on the cause of nerve root irritation.

   Pain is often accompanied with numbness, tingling or burning sensation in arms and hands. Weakness of muscles, difficulty in coordinated movements, problems with fine motor skills may also be noted.

2. Symptoms of Lumbar Nerve Root Irritation – When nerve roots in the lumbo-sacral region are irritated, it is lumbar nerve root irritation, which is common between the last two lumbar and between the last lumbar and first sacral vertebra (L4-L5 and L5-S1 region). It is presented with pain in lower back, buttocks, legs and may extend down till the feet.

   In this region, the sciatic nerve is most commonly affected and gives rise to nerve pain called sciatica. Complaints are typically present in the back of hips, thighs and runs along the sciatic nerve course through the back of legs. Pain is often sharp, shooting type with burning or stinging sensation. Numbness, tingling and sensation of pins and needles may also be present.

   Sometimes, pain can extend to other parts in the lower body, depending on the nerve roots involved. Weakness of legs, problems with bowel or bladder control can appear if the nerve root irritation is worse. Nerve root irritation at the thoracic spine region is rare, but needs to be evaluated if the physician suspects it.

Nerve root irritation or a pinched nerve can be diagnosed based on symptoms, clinical examination and imaging studies like MRI. Other investigations may be ordered as appropriate.

Treatment for nerve root irritation is mainly based on the cause and the presenting features. Treatment is aimed at reducing pain and discomfort, prevention from further damage and restoration of functional abilities.

Medications for Nerve Root Irritation: Pain medications, anti-inflammatories, muscle relaxants and nerve medicines may be advised as required. Nerve root irritation usually responds to nerve regeneration medications and other nutritional supplements may be considered.

Physical Therapy Treatment for Nerve Root Irritation: Physical therapy may be helpful in relieving entrapped nerve and release compression over the nerve roots. Warm and cold compresses, nerve stimulation, ultrasound for muscle relaxation, therapeutic exercises and postural training can help.

Back and Neck Brace for Relief from Nerve Root Irritation: Use of a cervical (neck) collar or lumbar support and rest may be advised for a certain period during acute pain. Followed by an initial rest period, graded exercises to strengthen the muscles and supporting structures under expert’s guidance are essential.

Epidural Injection to Treat Nerve Root Irritation: Epidural injection or nerve block may be considered as a part of investigations to find the exact cause of pain and also as a treatment modality for nerve root irritation. Epidural injection involves injecting a small amount of medicine, like anti-inflammatory or steroid, which helps to relieve pain and inflammation.

Surgical Treatment for Nerve Root Irritation: Surgery for nerve root irritation may be considered for cases that do not respond well to conservative approach. Worsening of symptoms and any alarming situation usually calls for surgery. Long term uncontrolled pain, worsening weakness and numbness, wasting of muscles and involvement of other body parts may be considered for surgical treatment options.