The spine is composed of stacked vertebrae separated by cushioning discs, protecting the delicate nervous system and neural pathways. Spinal compression occurs when an external or internal force reduces the space available for these neural structures. The resulting pressure on the nerves or the spinal cord disrupts the signals traveling between the brain and the body, leading to a variety of symptoms.
Defining Spinal Compression and Structures Affected
Spinal compression occurs when pressure is exerted on the nerve tissue housed within the spinal column. The spine includes the vertebrae, intervertebral discs, and the spinal canal and foramina, which are the hollow spaces through which the nerves pass. Compression of these structures diminishes the space available for the neural pathways.
Compression of the spinal cord itself is known as myelopathy. Conversely, compression of the individual nerve roots as they exit the spinal canal through the foramina is referred to as radiculopathy. Myelopathy tends to affect broader neurological functions, while radiculopathy typically results in symptoms localized to the specific body region served by the pinched nerve root.
Primary Conditions Leading to Compression
Spinal compression causes fall into two categories: sudden injuries and chronic, degenerative processes. Spinal stenosis, a common chronic cause, is a narrowing of the spinal canal or neural foramina. This narrowing develops over time due to osteoarthritis, leading to bone spurs (osteophytes) that encroach upon the neural space.
Degenerative disc disease (DDD) is another frequent contributor, where discs lose hydration and height, causing vertebrae to move closer together and potentially bulge outward. A herniated disc occurs when the soft inner material pushes through a tear in the tougher outer layer, directly compressing a nerve root or the spinal cord. These chronic conditions typically lead to a slow, progressive onset of symptoms.
Acute causes involve a sudden change in spinal structure, such as a traumatic injury resulting in a vertebral fracture. Fractured bone fragments can immediately compress the spinal cord, necessitating emergency treatment. Less commonly, compression arises from non-degenerative issues like spinal tumors (abnormal growths that take up space) or from infections and abscesses that cause swelling near the neural structures.
Recognizing the Signs of Compression
Symptoms vary significantly based on whether the spinal cord or a single nerve root is affected. In radiculopathy (nerve root compression), the primary complaint is radiating pain, numbness, or tingling that follows the nerve path into an arm or leg. A common example is sciatica, where compression of a nerve root in the lower back causes pain that travels down the leg and into the foot. Muscle weakness and decreased reflexes may also be isolated to the limb served by the compressed nerve.
Myelopathy (spinal cord compression) symptoms are generally more widespread and involve a loss of coordinated function. People may notice difficulty with balance and walking, often described as a wide-based or clumsy gait. Fine motor skills can be impaired, making simple tasks like buttoning a shirt or writing difficult.
A severe form of compression, such as cauda equina syndrome in the lower spine, constitutes a medical emergency, presenting with sudden loss of bowel or bladder control. Other signs include numbness in the “saddle” area around the groin and inner thighs, along with profound weakness in the legs. Any rapid onset or worsening of these severe symptoms requires immediate medical attention to prevent permanent neurological damage.
Management and Treatment Approaches
Treatment for spinal compression is tailored to the severity, location, and cause, usually starting with conservative methods. For many cases of nerve root compression, a period of rest and activity modification helps reduce inflammation and irritation. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to manage pain and swelling, and physical therapy is often a cornerstone of conservative care.
Physical therapy focuses on strengthening spinal muscles, improving flexibility, and teaching proper body mechanics to prevent future irritation. If pain persists, a physician may recommend epidural steroid injections, which deliver powerful anti-inflammatory medication directly to the area around the compressed nerve root to reduce swelling. These conservative measures are often successful in relieving symptoms, especially for radiculopathy.
When symptoms are severe, progressive, or unresponsive to conservative management, or if signs of myelopathy are present, surgical intervention may be necessary. Surgical goals are to decompress neural structures by creating more space within the spinal canal or foramina. Procedures like laminectomy remove the bony arch of the vertebra to relieve pressure on the spinal cord, while a foraminotomy widens the opening where the nerve root exits. Depending on the cause, surgery may also involve a discectomy to remove a herniated disc, sometimes followed by spinal fusion to stabilize the vertebral segment.