Will my Compressed Spinal Nerve Heal or be Damaged Permanently?

Orthopaedic & Spine Center
Dr. Carlson

Jeffrey R. Carlson, MD, CPE, FAAOS

Every day, I see patients for arm or leg pain and numbness related to pinched nerves in their spine.  These patients all have differing degrees of pain and dysfunction from their back and neck problems.  Each patient deals with their symptoms individually, so there are varying degrees of dysfunction from the same diagnosis. Compressing or pinching the nerves in the spine comes from a bone or disc putting pressure on the nerve.  The nerve then produces pain, numbness and weakness, tracking down the length of the nerve.  In the neck, this will lead to nerve pain into the arm and in the lower back, the nerve pain will track down the length of the nerve to the foot, termed “sciatica”. 

The nerve carries the information from the brain to the rest of the body and back to the brain.  Nerve compression can cause pain, numbness, tingling and when the nerve is really compressed, will cause weakness.  Weakness is concerning as this means the muscle is not getting the information from the brain to allow it to fire and be useful.  This amount of compression that causes weakness will be best treated with surgery.  However, most patients will have pain and numbness in the nerve distribution without weakness which can be managed with medications, injections or physical therapy to help relieve the pressure on the nerve. 

I am often asked if the pinching of the nerve will cause permanent damage.  A recent article from The Journal of Orthopaedic Surgery and Research (December 17, 2022) gives us some guidance.  They observed their patients with lumbar spinal stenosis before and after surgery to determine their surgical outcomes in relation to their pre-operative leg pain and numbness.  Two years after surgery, those patients with numbness for longer than 3 months prior to their surgery had worse leg pain and quality of life compared to those patients that had surgery earlier for their pain.  The thinking behind this study suggests that the nerve can only tolerate being compressed for 3 months before there will be notable permanent damage that a surgery will not be able to correct.  This seems to make sense, in that; constant pressure on any type of living tissue will cause some residual damage.  The earlier that pressure can be removed the more likely the tissue damage can recover

The initial treatment for most patients with pinched nerves will be non-operative, however the longer the nerve is compressed and symptomatic, the more likely that nerve will not recover completely even after successful surgery.  From this study, it is recommended that if non-operative treatment is not making meaningful improvements in your symptoms within 3 months, surgery will be the best option to prevent permanent injury and have a more successful outcome. Even if the symptoms have lasted more than 3 months, surgery for removing the pressure from the nerve will still improve your pain and numbness, just not as well as it would have if the pressure was removed earlier.