What causes neck nerve compression?

Causes of Neck Nerve Compression

Neck nerve compression is primarily caused by degenerative spine disease, disc herniations, and spinal malalignment, which account for the majority of cases in clinical practice. 1

Common Etiologies

Structural/Mechanical Causes

• Degenerative changes:

  • Cervical spondylosis (most common cause)
  • Disc herniations
  • Osteophytes (bone spurs)
  • Facet joint arthropathy
  • Ligamentum flavum hypertrophy
  • Congenitally short pedicles (predisposing factor)

• Spinal alignment issues:

  • Malalignment of vertebrae
  • Atlantoaxial instability 2
  • Spinal deformity

Space-Occupying Lesions

• Neoplastic:

  • Primary tumors (schwannomas, neurofibromas)
  • Malignant peripheral nerve sheath tumors
  • Metastatic tumors 3

• Non-neoplastic masses:

  • Epidural hematoma
  • Epidural abscess
  • Aneurysm
  • Amyloidosis 3
  • Post-surgical complications (seromas, pseudomeningoceles) 3

Inflammatory/Immune-Mediated

• Demyelinating conditions:

  • Multiple sclerosis
  • Neuromyelitis optica
  • Acute disseminated encephalomyelitis 3

• Systemic inflammatory diseases:

  • Systemic lupus erythematosus
  • Sjogren syndrome
  • Mixed connective tissue disorder
  • Behcet disease
  • Sarcoidosis 3

Vascular

• Ischemic causes:
  • Atheromatous disease
  • Aortic surgery complications
  • Systemic hypotension
  • Thoracoabdominal aneurysms or dissection
  • Sickle cell disease
  • Spinal arteriovenous malformations 3

Pathophysiological Mechanisms

Nerve compression involves both mechanical and ischemic factors:

1. Initial compression causes local pressure on the nerve
2. Connective tissue changes develop with fibrosis and thickening of external epineurium and perineurium
3. Vascular compromise occurs as vessels passing through the epineurium are compressed
4. Demyelination is the initial pathological change
5. Axonal injury develops with prolonged compression 4

The severity of neural dysfunction follows a dose-response curve: greater duration and amount of pressure lead to more significant dysfunction 4.

Clinical Presentation by Location

Cervical Radiculopathy

• Sharp, radiating pain along the affected nerve root distribution
• Sensory deficits in corresponding dermatomes
• Motor weakness in corresponding myotomes
• Diminished reflexes 5

Brachial Plexopathy

• Often difficult to distinguish from radiculopathy due to overlapping presentations
• May present with more diffuse arm symptoms not limited to a single nerve root distribution 3

Cranial Neuropathy

• Symptoms depend on the specific cranial nerve affected
• May include oropharyngeal dysphagia or pain when involving lower cranial nerves 3

Diagnostic Approach

MRI is the gold standard imaging modality for evaluating nerve compression in the neck, offering superior soft-tissue resolution and multiplanar capability 3. CT provides better bony detail and is useful when MRI is contraindicated 1.

Management Considerations

Treatment should be based on the grade of neck pain and presence of neurological deficits:

• Grade I/II (no major pathology): conservative management
• Grade III (neurological signs): may require more aggressive intervention
• Grade IV (signs of major pathology): often requires surgical management 1

Most patients with cervical radiculopathy improve over time with focused, nonoperative treatment 5. Surgical intervention should be considered for patients with progressive neurological deficits, myelopathic signs, or failure of conservative management after 6-8 weeks 1.

Key Pitfalls to Avoid

1. Overlooking red flags that suggest serious underlying pathology requiring immediate attention
2. Relying solely on imaging without clinical correlation (degenerative findings are common in asymptomatic individuals)
3. Delaying appropriate intervention in patients with progressive neurological deficits
4. Failing to consider multi-level pathology as a cause of complex presentations
5. Missing non-spinal causes of neck and arm pain that may mimic radiculopathy

Understanding the various causes of neck nerve compression is essential for appropriate diagnosis and management to prevent long-term neurological dysfunction and disability.