Pinched nerve in the cervical spine in adults and children

If in common parlance they say "pinched cervical nerve", then a more precise medical formulation is the definition: pinched cervical spinal nerve roots or cervical plexus nerve roots. And this is one of the most common causes of neurological problems associated with the neck. [ 1 ]

Epidemiology

Dysfunction of the nerve root of the cervical spine can occur in people of any age, but, according to statistics, most often the pinching of the root occurs at the age of 40-50 years. [ 2 ]

And its prevalence is estimated at approximately 64-107 cases per 100 thousand people. [ 3 ]

Causes cervical plexus nerve root impingement.

In the posterior triangle of the neck (scapulotrapezoid), opposite the four upper cervical vertebrae (under the sternocleidomastoid muscle), there is a network of interconnected anterior branches of spinal nerves CI-CIV, emerging from the spinal cord of the cervical spine through the intervertebral (foraminal) openings. This local nerve network, called the cervical plexus, is part of the peripheral nervous system.

Each of these nerves originates from the motor (anterior) and sensory (posterior) roots - the axons or processes of the corresponding neurons, which, leaving the foraminal opening, join together into mixed fibers (conducting efferent and afferent impulses).

The first three cervical nerves (CI, CII, and CIII) are involved in movements of the head and neck; the CII dermatome provides sensation to the top of the head, and the CIII dermatome to the back of the head and part of the face.

The cervical plexus forms smaller nerve branches. Thus, the upper roots CI-CII and the lower roots CII-CIII form the nerve loop Ansa cervicalis, which provides innervation of the hyoid muscle, which is involved in swallowing and articulation. Several other branches depart from the nerve roots of the cervical plexus (the small occipital and great auricular nerves, the transverse cervical and supraclavicular nerves) and provide motor innervation of the skeletal muscles of the neck, as well as sensory innervation (skin sensations) in parts of the back of the head, neck and shoulder. In addition, sympathetic sudomotor and vasomotor nerve fibers pass through the cervical plexus to the blood vessels and sweat glands. [ 4 ]

The main causes of pinched cervical nerves are related to:

• cervical spine injuries;
• protrusion of the disc between the vertebrae of the neck or herniated disc;
• degenerative changes in the spine, for example, with cervical osteochondrosis;
• localized in the cervical spine spondyloarthrosis;
• cervical spondylosis or diffuse idiopathic skeletal hyperostosis;
• hypertrophy of the facet joints of the vertebrae, leading to cervical facet syndrome;
• the formation of spinal cord tumors.

In addition to injuries and neoplasms localized in the cervical spine (primarily perineural cysts), cervical nerve entrapment in a child may be caused by congenital non-fusion of the cervical vertebral arches – spondylolysis.

Due to trauma during birth (during passage through the birth canal), with short neck syndrome or congenital muscular torticollis, as well as due to careless handling of the infant (who begins to hold his head only at 2.5-3 months), the cervical vertebrae can shift, which causes pinching of the cervical nerve in newborns. [ 5 ]

Risk factors

In fact, pinching of any nerve is a pathological process, and, in addition to the already listed reasons for its development, experts include the following risk factors for pinching a nerve in the cervical spine: decreased bone mineral density, which increases the likelihood of spinal column injuries (spontaneous fractures); in children - rickets; in adults - degenerative-dystrophic pathologies of the vertebral joints of the neck; Bechterew's disease; kyphosis of the cervical spine, hypertrophy of periradicular fibrous tissues, long-term posture disorders, etc.

Pathogenesis

The mechanism of action on the motor and sensory roots of the nerves of the cervical plexus (vulnerable to damage due to the poorly developed connective tissue sheath - epineurium) lies in the disruption of the functions of the peripheral nervous system, that is, a disruption of nerve conduction is observed. [ 6 ]

The pathogenesis of pain that occurs with compression of the cervical nerves and stenosis of the intervertebral foramen is considered in more detail in the publication – Neuropathic pain [ 7 ]

In adults, cervical osteochondrosis and pinched nerve are most often combined. More information in the material - Osteochondrosis of the spine: neurological complications

Symptoms cervical plexus nerve root impingement.

When the root of the cervical plexus nerve is pinched, cervical radiculopathy (from the Latin nervi radix – nerve root) or neuralgia develops, and its first signs are manifested by neck pain – at the back and side.

Pain from a pinched nerve in the cervical region can be dull, aching or burning and shooting - at rest, as well as when bending and unbending the neck and turning the head. At later stages, radiating pain appears in the fingers and hands.

In addition, neuralgic symptoms include limited movement in the cervical spine and sensory disturbances – paresthesia, which manifests itself as numbness of the skin and tingling, spreading to the neck and back of the head, shoulder and collarbone, submandibular region and upper part of the shoulder blades. In most cases, cervical radiculopathy manifests itself on one side, but bilateral symptoms are also possible. [ 8 ]

Headaches are also common when a nerve in the cervical region is pinched, and when there is a lack of oxygen entering the brain with the blood flow, dizziness and even fainting can occur when the cervical nerve is pinched.

Although movement disorders due to pinched cervical spinal nerves are rare (because the muscles they control are typically highly innervated), movement problems may still occur: with CI-CII compression, neck flexion and extension are difficult; lateral flexion of the neck when tilting the head is limited (with CIII pinched); shoulder elevation and abduction (CIV-CV), elbow flexion and wrist extension (CVI), elbow extension and wrist flexion (CVII), and thumb extension (if the cervical nerve root CVIII is pinched) may be difficult. [ 9 ]

More information in the article - Symptoms of damage to the cervical plexus and its branches

Complications and consequences

Characteristic consequences and complications include: numbness of the fingers and weakening of the hands; development of cervical migraine (chronic pulsating headache with dizziness and tinnitus) – Barre-Lieou syndrome; development of paraparesis and paraplegia.

There may also be a reduction in the length of the muscles of the cervical spine and its weakening, stiffness of the joints, and persistent posture disorders.

Diagnostics cervical plexus nerve root impingement.

To make a diagnosis, a physical examination of the patient, recording of his complaints and a complete anamnesis are necessary.

Instrumental diagnostics are used for visualization:

• X-ray of the cervical spine with spondylometry;
• MRI or CT scan of the neck;
• Ultrasound of nerves;
• electromyography. [ 10 ]

Differential diagnosis

Specialists also conduct differential diagnostics with vertebrobasilar syndrome of vascular etiology; with cervical myofascial pain syndrome with myositis of the neck or myogelosis; with demyelinating polyneuropathies (including syringomyelia), as well as peripheral motor neuropathies with focal lesions of the central nervous system and diseases of motor neurons; with neuralgic amyotrophy (Parsonage-Turner syndrome), etc. [ 11 ]

Treatment cervical plexus nerve root impingement.

Etiological treatment is aimed at the cause of the pinching, that is, it is necessary to treat cervical osteochondrosis, displacement of vertebrae or treatment of vertebral hernia.

Symptomatic treatment involves the doctor prescribing painkillers for a pinched cervical nerve. [ 12 ]

First of all, these are tablets such as: Paracetamol, Ibuprofen (Ibuprom, Ibufen, Nurofen, Imet, etc.), Ketanov, Diclofenac and drugs containing sodium diclofenac; Renalgan (Maxigan). Also read - Tablets for neuralgia.

Vitamins B1, B6 and B12 may be prescribed.

Treatment at home is carried out using local remedies, these are gels and ointments: Menovazan, Deep Relief and Dolgit (with ibuprofen), remedies with nimesulide or ketoprofen. For more details, see - Ointments for neck pain

In case of severe pain syndrome, pain-relieving injections are also prescribed for pinched cervical nerves - peri- or paraneural novocaine blockade.

More details in the publication - Treatment of neuropathic pain

The standard treatment for movement problems in nerve conduction disorders is physiotherapy, see - Physiotherapy for neuritis and neuralgia of peripheral nerves

Patients are prescribed therapeutic massage (to improve muscle trophism) and special gymnastics for pinched cervical nerves - to maintain the existing range of motion. It is necessary to systematically perform such exercises for pinched cervical nerves as contralateral rotation and lateral bends of the neck while standing or sitting, lifting the head with anterior flexion of the neck in a lying position, isometric exercises for the muscles of the upper limbs, etc.

Read also:

• Physiotherapy for cervical osteochondrosis
• Displacement of cervical vertebrae

In cases of low efficiency of conservative therapy and obvious motor deficit, surgical methods are used: anterior dissection or corpectomy (decompression) of the cervical vertebra, arthroplasty of the intervertebral disc, laminotomy or foraminotomy.

Prevention

Is it possible to prevent pinched nerves? If you do not injure the cervical spine, watch your posture, and maintain a healthy and physically active lifestyle, then the risk of developing this pathology can be reduced.

Forecast

In case of pinching of the cervical nerve – the root of the nerve of the cervical plexus, the prognosis of its outcome and neurological consequences is directly related to the cause. [ 13 ] Unfortunately, the consequences can be chronic (irreversible).