Treating Nerve Root Encroachment Surgically

Why decompressive surgery is sometimes needed

Overweight Mature Person With Lower Back Pain
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The pain, weakness, numbness, and tingling associated with nerve root encroachment is usually first treated with non-surgical therapies, such as anti-inflammatory medication and physical therapy. This may be enough to address the irritation of the spinal nerve root. Persistent and severe cases, however, may require surgery to ease nerve compression and improve symptoms.

Decompressive surgery may be done in a couple of different ways. Regardless, the procedure is a serious one and does not come with a guarantee for complete pain relief.

Causes and Symptoms of Nerve Encroachment

Vertebrae are bones in your spine that are stacked one upon the other. Within each vertebra is a hole in the center (called a foramen), and within each foramen is a type of nervous tissue called a spinal nerve root. When you have nerve root encroachment, abnormal tissue moves in on the spinal nerve root.

Nerve root encroachment is often caused by degenerative ("wear and tear") changes in the vertebrae, which is part of the normal aging process. Specifically, these degenerative changes may lead to the formation of bone spurs called osteophytes. If the osteophytes "encroach" and compress on a nerve root, symptoms (e.g., pain, numbness, or weakness) may develop, but not always.

Material from a herniated disc and thickened spinal ligaments can also encroach on nearby nerve roots.

When Surgery Is Indicated

When symptoms do occur, initial treatment will involve nonsteroidal anti-inflammatories (NSAIDs), physical therapy, and/or an injection of corticosteroids into the spine.

If these conservative therapies are not helpful or there are neurological problems present—like difficulty with balance or walking— surgery may be considered. Severe pain that limits everyday functioning is an additional indication for surgery.

Rapidly progressive weakness of the arms and/or legs or signs of cauda equina syndrome (e.g., loss of bladder/bowel control) are indications for urgent surgery.

Spine Surgery Options

There are different types of spinal surgery that may be performed. A neurosurgeon will decide what the best procedure for each patient is based on their unique problem, as well as their age, other medical conditions, and other factors.

That said, there are two main approaches to spinal decompression—anterior and posterior surgeries.

According to the American Academy of Neurosurgeons, the goals of spine surgery are to:

  • Decompress or relieve pressure on the nerve roots
  • Maintain or improve the stability and alignment of the spine

Anterior Surgical Approach

The anterior approach to surgery means that the spine is accessed through the anterior part (front) of the spine.

For example, in order to alleviate pressure on one or more nerve roots in the cervical (upper) spine, an anterior cervical discectomy may be performed. In this surgery, one or more discs and bone spurs are removed through an incision in the front of the neck.

With an anterior lumbar interbody fusion, a surgeon removes a degenerative disc in the lumbar (lower) spine by going through a patient's lower abdomen. After removing the disc, a structural device, often made of bone, is used to replace the space where the disc once was. This device encourages bone healing and helps the bodies of the vertebrae to eventually fuse together.

Posterior Surgical Approach

The posterior approach to surgery means that the spine is accessed through the posterior part (back) of the spine.

For example, in order to remove a thickened ligament, bone spur, or disc material in the neck, part of the back of the vertebrae (called the lamina) may be removed through a small incision in the back of the neck. This is called a posterior cervical laminectomy.

With a posterior lumbar interbody fusion, a degenerative disc is removed by the surgeon going through the skin in the back. Similar to the anterior approach, a structural device that often contains bone is used to fill the space where the disc once was to facilitate bone fusion.

Risks

As with any surgery, it's important that you and your doctor carefully weigh the potential benefits of these procedures against the risks.

Some of the risks that may occur from spine surgery include:

  • Infection (e.g., wound, urinary tract, or lung)
  • Bleeding
  • Blood clots
  • Intestinal blockage

There are also risks specific to the area of the spine being operated on and how it is surgically approached (anterior vs. posterior). For example, with a cervical anterior approach, there is a risk that the esophagus (the tube that connects your mouth to your stomach), trachea (windpipe), or carotid artery may be injured.

Likewise, damage to the C5 nerve root (called C5 palsy) may occur from cervical spinal decompressive surgery. This complication causes weakness, numbness, and pain in the shoulders.

Very rarely, the spinal cord may be injured during surgery and result in paralysis.

A Word From Verywell

If you or a loved one is considering a decompressive surgery, it is important to have informed conversations with your neurosurgeon. As you may or may not get relief from such a procedure, the pros and cons in your specific case must be carefully weighed.

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