Pinched Nerve or Spinal Cord Compression? How to Tell the Difference
Pain that shoots from your lower back down one leg can be a sign of a pinched nerve. Trouble fastening your shirt buttons, especially if you’ve also started feeling unsteady on your feet, tells a different story. Both problems can start in the spine. The difference is which structure is under pressure, and which messages it carries.
Think of your spine as a protective tunnel. Inside it, the spinal cord acts like a main electrical cable, carrying messages between your brain and your body. Smaller cables, called nerve roots, branch off and serve particular areas. Pressure on one branch can cause symptoms along its route. Pressure on the main cable can affect several routes at once.
What does a pinched nerve feel like?
A nerve root can become irritated or squeezed where it leaves the spine. A bulging disc may press against it, or changes from arthritis may narrow the opening it passes through. You might feel burning or shooting pain, pins and needles, numbness or weakness in the area that nerve supplies.
Sciatica is a familiar example. You might feel pain in one buttock that travels down the back of your leg, sometimes as far as your foot — and the leg pain can be more noticeable than the backache. When a nerve root in the neck is affected, pain or tingling can travel through the shoulder and down an arm into the hand instead. Where the symptoms travel gives your doctor a clue about which nerve to examine.
What does spinal cord compression feel like?
Spinal cord compression happens when something presses on the cord itself, inside the spinal canal. One possible cause is narrowing of the canal in the neck. Because messages to both the arms and legs pass through this part of the cord, pressure here can affect your hands and your walking at the same time.
The first change you notice might be an everyday task becoming harder. You may fumble with buttons, drop things more often, or find yourself reaching for the handrail because your balance feels different. Mention these changes when you speak to your doctor, even if pain is not your main concern.
Can you have both at once?
Yes. A disc problem in the neck can put pressure on a nerve root and the spinal cord at the same time. Someone might experience shooting pain down one arm as well as changes in balance or hand coordination. Describing both sets of symptoms helps your doctor decide what to check.
When should you seek emergency care?
Go to your nearest emergency department immediately if you develop any of the following, particularly alongside back or neck symptoms:
- New or rapidly worsening weakness in your arms or legs.
- Sudden difficulty walking or a marked loss of balance.
- New difficulty passing urine, inability to urinate, or loss of bladder or bowel control.
- New numbness around your genitals, buttocks or inner thighs, sometimes called saddle numbness.
Bladder changes and saddle numbness can also occur when the bundle of nerves in the lower back, called the cauda equina, is compressed. This needs emergency assessment. If you notice these warning signs, go straight to the emergency department rather than waiting for a specialist appointment.
What can an MRI tell you?
If your MRI report mentions a disc bulge or spinal stenosis, it’s understandable to wonder whether your spinal cord is being squeezed. Stenosis simply means narrowing. The next question is where that narrowing occurs, whether it presses on a nerve root or the cord, and whether the finding explains what you’re experiencing. Your neurosurgeon considers the scan alongside your symptoms and an examination of your strength, sensation and reflexes.
If pain, tingling or numbness persists, arrange a medical assessment. Before your appointment, jot down where the symptom starts, where it travels, and what has become harder to do. “The pain runs from my buttock to my foot” or “I’ve started dropping my keys and I feel unsteady on stairs” gives your doctor a clearer picture than “my back feels wrong”.
Take the next step
Ongoing nerve pain, or changes in coordination and balance, deserve attention. An assessment can help identify the cause and guide the most appropriate treatment.
Contact your neurosurgeon to arrange a consultation if you are experiencing persistent symptoms.
This article provides general information and does not replace an individual medical assessment.