The Potential for Neurological Recovery:

Peripheral and spinal nerves have the capacity to recover from injury and regain function when treated early enough.  For this reason, it is always important that a timely workup be performed to identify the location and source of neurological compromise, so that an appropriate treatment plan can be implemented to promote full neurological recovery.  Beyond a certain time frame injured nerves have less potential for full or even partial recovery. 

Spinal nerve roots are organized in a very unique fashion, similar to the wires on the inside of a conduit.  A spinal nerve is essentially a conduit of multiple nerve fibers, which traverse through it.  It is not really “one nerve.â€?

Nerve Damage and Scarring:

The surroundings of an injured nerve influence the pattern of recovery.  Inflammation around a nerve can lead to the formation of scar or adhesions, which can adhere to the nerve and restrict its movement.  Recurrent tugging and pulling of a spinal nerve and adjacent tissue can lead to the release of inflammatory chemicals referred to as bradykinins, which cause swelling and inflammation.  The presence of high concentrations of inflammatory chemicals can alter the structural, chemical and electrical properties of the nerve.  Chemically induced neurological compromise responds quicker to therapeutic intervention than structural damage.  Physical alteration of a spinal nerve takes longer to recover than uncomplicated inflammation.  Persistent pressure mechanically deforms the spinal nerve leading to reduction of its blood supply causing inflammation.  This results in altered signal transmission leading to symptoms such as pain, numbness, or weakness.  Once the pressure is removed from the nerve, the nerve is no longer physically deformed and its blood supply returns, allowing for recovery to occur.

One of the most problematic aspects of nerve compression is the development of the scar tissue or “fibrosis.â€?  The term fibrosis describes a chain of events, which occurs as a result of activation of specialized cells referred to as fibrocytes.  These cells produce scar (fibrous) tissue.  The normal purpose of these specialized cells is to migrate to a region of injury and produce replacement tissue, which helps seal the area to provide stability and facilitate recovery.  Over activation or chronic stimulation of fibrocytes can lead to excessive scar tissue development.  This dynamic process is referred to as fibroproliferation.  When this occurs within or around an injured nerve it can reduce the potential for neurological recovery.

Spinal nerves normally move (glide) within the central spinal canal and through the openings along the side of the spine (neuroforamen) during extremity and other bodily movements.  If there is a scar tissue adhering to the nerve, extremity movements will lead to deleterious tugging and stretching of nerve tissue causing symptoms.