Technique of tensing the stomach muscles to support the spine. Patients are instructed to practice this during all movements in bed, when walking and even when wearing a brace or corset. Eventually this becomes automatic and patients develop a natural support for their spine.
A method of producing pain relief by inserting fine, wire-thin needles into the skin at specific sites on the body along a series of channels, called meridians. Some studies suggest this may be helpful for patients suffering from neck and back issues.
Any physical exercise demanding additional effort from the heart and lungs to deliver a continuous amount of oxygen to the skeletal muscles. This exercise generally requires heavier breathing than passive muscular activity and results in increased heart and lung efficiency with minimum wasted energy. Examples of aerobic exercises include running, jogging, swimming, vigorous dancing, and cycling.
A physician trained in the administration of anesthesia to allow a patient to go asleep during surgery. They carefully monitor the patient in the operating room and administer medication to minimize pain. Some anesthesiologists also specialize in spinal injections.
A tear in the outer layer of the disc (annulus fibrosus). As the tear approaches the surface of the annulus, pain may occur due to an inflammatory response as well as stimulation of nerve fibers.
The tough, outer portion of the disc composed of multiple fibrocartilaginous rings. These rings firmly attach to the vertebra above and below the disc and help to hold these segments together. Approximately 70% of the total disc is composed of the annulus fibrosus. Although this structure is typically torn with a disc herniation, it is not removed during the procedure of a microdiscectomy.
The front of a structure.
Anterior Cervical Discectomy and Fusion (ACDF)
A surgical procedure on the cervical spine (neck) where one or more discs are removed from the front (anterior) and replaced with bone graft. A plate and screws are often placed as well to stabilize the level while a fusion takes place.
Anterior Lumbar Interbody Fusion (ALIF)
A surgical procedure where the lumbar spine is fused from the front of the patient’s body.
A substance that reduces irritation, inflammation, and/or injury to tissues of the body.
Medications which prevent or delay the clotting of blood.
Inflammation resulting in adherence of nerve rootlets within the dura (a sheath containing the spinal cord and/or nerve roots).
Pertaining to the patient’s own body.
Blood donated by a patient prior to surgery and given back to them at the time of their surgery.
Autologous Bone Graft
Bone tissue taken from the patient at the time of surgery. This is usually used for fusing vertebrae together during spinal surgery. The bone is often taken from the ilium of the pelvis.
A procedure in which a concentration of a radioactive substance that has an affinity for a specific tissue is injected into the blood stream to enhance the images of bone activity. This exam may be ordered when there is concern for a possible infection, recent fracture, or tumor. A few hours prior to the exam, a tracing substance will be injected into a vein in the arm. The patient will then go to the Nuclear Medicine Department where he/she will lie flat on a table. A scanner will move slowly over their body taking pictures. The exam takes approximately 1-2 hours to complete and subjects the patient to very little radiation.
A condition in which the nucleus pulposus of the disc pushes out against the annulus fibrosus causing it to bulge. These are often associated with normal aging of the discs, but may occasionally place pressure on nerves.
A structure (usually plastic or metal) that is filled with bone graft and inserted into the disc space once the disc has been removed. This helps re-establish the normal height of the disc space and facilitates a fusion since it is usually filled with bone graft.
Of, or pertaining to, the neck or region of the neck.
A system of treatments in which there is manipulation or mobilization of parts of the musculoskeletal system to provide pain relief. Chiropractic treatments of the spine can often provide short-term relief.
Stocking-like boots placed on the calves in the lower extremity and connected to a pneumatic pump. They provide stimulation to the vasculature of the lower extremity, when immobile, to reduce the risk of blood clots.
Computed Tomography (CT Scan)
A highly sophisticated x-ray exam which produces 3-dimensional images of the body, joints, nerves, discs, bones, and tissues. The scans are taken at regular intervals through the body part of interest as the patient lies on a table which moves slowly through the CT Scan machine. The imaging data are collected by the x-ray tube moving opposite a series of detectors. The detectors transmit the data signals to a computer where they are mathematically processed and reconstructed into images. These images are then processed by a computer and printed. It is important that the patient lie absolutely still throughout the procedure. The exam takes less than an hour. The patient is subjected to radiation for this procedure.
These are benign fluid filled cysts in the spine that develop from degeneration of the facet joints. They can cause nerve compression and occasionally have to be removed surgically.
A procedure involving surgical excision of structures causing pressure on nerves most commonly from bone spurs (osteophytes), ligaments, cysts, and/or disc herniations.
Degenerative Disc Disease (Misnomer- not a disease)
A NORMAL wear-and-tear process of the spine which occurs with aging. This affects all of us if you live long enough. Degenerative changes can be noted as early as the teenage years. Genetics as well as environmental factors (i.e., trauma and normal wear & tear) can result in the discs losing water. Tears in the annulus fibrosus may also occur. This, in turn, causes the vertebrae to come closer together producing increased stress on bones, joints, and ligaments. Pain may or may not occur with this condition. Even though the condition may persist or progress, it can sometimes be controlled with proper mechanics and strong muscles.
Disc (Intervertebral Disc)
The oval-shaped wedges of fibrocartilage found between adjacent vertebrae. The tough, fibrous outer portion is called the annulus fibrosus. It is composed of multiple fibrocartilaginous rings. These rings firmly attach to the vertebrae above and below the disc and help hold the segments together. The inner portion is called the nucleus pulposus and is composed of approximately 80% water. The inner nucleus pulposus actually looks and feels like crab meat. The primary functions of the discs are to act as shock absorbers and to transfer mechanical stresses to allow for smooth movement. The discs also add stability to the spine by virtue of the fact they operate on a pressure gradient system.
A procedure involving surgical excision of the nucleus pulposus which has pushed or broken through the outer rings of the disc. Healthy disc is actually adhered to bone. During surgery, we only remove loose disc material. The remaining portion of the disc is left intact.
Dual-Energy X-ray Absorptiometry Study (DXA)
A radiographic test that measures bone mineral density (BMD) in order to identify osteoporosis, risk for fractures (broken bones), and response to osteoporosis treatment.
A sheath containing the spinal cord and/or nerve roots.
Abbreviation for electrocardiogram. A test in which a graphic record is produced to record the electrical activity of the heart to detect abnormal transmissions of heart impulses through the conductive tissues of the heart muscles. An EKG allows diagnosis of specific cardiac abnormalities. Leads are affixed to certain points on the patient’s chest, usually with an adhesive gel that promotes transmission of the electric impulses to the recording device. The patient is positioned lying down on his or her back on an examining table and asked to lie still during the test. It takes approximately 30 minutes to complete.
Abbreviation for an electromyography. A diagnostic procedure to assess the health of muscles and nerves. Small needles are placed in various muscles and the response of the muscles to electrical current is interpreted by a specialist.
A procedure where bone spurs (osteophytes), cysts, and/or disc herniations are removed from the foramen (bony hole where a nerve exits) to take pressure off of the exiting spinal nerve. The incision is often made more lateral (away from the midline) in order to decompress the nerve from “outside to in” versus a laminotomy where you are decompressing the nerves from “inside to out.”
Extrusion (of Disc)
A specific type of herniated disc in which a large amount of disc material breaks through the outer rings of the annulus, usually causing extreme pressure on the nerve(s). In this type of herniation, the base of the herniation is smaller than the tip.
A diagnostic and therapeutic procedure done to determine how much pain is coming from the facet joint. Patients with pain from their facets may obtain pain relief with this procedure.
The small joints in the back of the spine where two vertebrae overlap one another. They function to guide and restrict movement of the spine. These joints are lined by cartilage, lubricated by synovial fluid, and surrounded by a capsule. They are a common cause of neck/back pain as they become arthritic (loss of articular cartilage in the joint).
Done to determine the quality of motion and alignment of the spine. They can also help diagnose a spondylolisthesis (slippage of one vertebra over another). While standing, the patient is asked to bend forward, with a rounded back, as far as possible. As the patient holds this position, an x-ray is taken. This is then repeated with the patient bending their back backwards. Patients are asked to go to the limit of motion in bending both forward and backward in order to obtain accurate information. The exam takes approximately 10 minutes.
A tube placed thru the urethra and into the bladder to drain urine.
Foramen (Intervertebral foramen)
The hole created when two vertebrae are placed together. As a spinal nerve branches from the spinal cord it travels in the spinal canal and exits through this hole.
A surgical procedure joining two or more spinal vertebrae. This is usually performed in order to stabilize the spine and/or take pressure off of nerves. Most often one or more discs are removed and replaced with bone graft (either from a bone bank or the patient’s iliac crest). Metal screws and rods or a plate may also be used to help stabilize the spine while the fusion becomes solid.
A term used to describe a condition in which the nucleus pulposus protrudes out of the normal boundaries of the annulus fibrosus. The severity of the symptoms vary according to the size, location, and chronicity of the herniation. There are three types of herniations: protrusions, extrusions, and sequestered or free fragments.
A device that measures the volume of inhaled air. It is usually used after surgery to provide adequate lung expansion and oxygenation to all sections of the lungs.
The protective response of body tissue to irritation or injury.
Permission obtained from a patient to perform a specific test or procedure. Informed consent is required before performing most invasive procedures and before admitting a patient to a research study. This document describes the procedure or test and associated risks.
When a patient stays overnight in a hospital after their surgery.
A condition in the spine which results in excessive motion occurring between two or more vertebrae. It is usually the result of degenerative changes in the spine. This most often occurs when one vertebrae slips forward with respect to another vertebrae (spondylolisthesis). Flexion-extension x-rays are often helpful in making this diagnosis. A fusion is sometimes required to stabilize this section of the spine.
A bony structure that is part of the vertebral arch that forms the roof of the spinal canal. It protects the nerves. A small portion of this often needs to be removed in order to perform a microdiscectomy. Removal of a small portion of this bone does not cause instability and often grows back.
A laminotomy is a procedure involving surgical removal of a portion of the bony arch of the vertebrae, called the lamina, which covers the spinal canal. A laminectomy is when the whole lamina is removed on one or both sides of the vertebra. A laminotomy and laminectomy are typically performed to remove pressure from nerves. A laminotomy is performed much more frequently than a laminectomy with modern techniques.
Of, at, toward, or from the side or sides. Away from the midline of the body.
This ligament attaches the laminae together between adjacent vertebrae. It means “yellow ligament” in latin. It can enlarge with age and pinch nerves. The ligament is residual from development. It’s removal has no negative consequence since it has no role in the stability of the spine.
A technique used to turn in bed. Patients are instructed to brace their stomach muscles and move their shoulders and hips at the same time to prevent twisting their spine. This is especially helpful for patients following spine surgery since twisting is often painful and stressful to the surgical site.
Pertaining to the lower back.
Magnetic Resonance Imaging (MRI)
A special study often used to diagnose spinal conditions. Images are obtained by using a high-strength magnetic field and radiowaves which allow for high resolution images of the spine without the ionizing radiation effects associated with x-rays. A patient enters a large room, lies on a narrow sliding bed, and is placed inside a very large metal, tunnel-shaped tube (magnet). Nothing touches the body and no sensations are felt during the test. The patient will hear a repetitive tapping noise which occurs while the machine is taking pictures from various angles. The entire examination should take less than one hour. It is important the patient remain motionless and relaxed while scans are obtained.
A surgical procedure usually performed as an outpatient, to remove a herniated disc (nucleus pulposus) which has been determined to be the source of a patient’s nerve pain.
A form of manual therapy in which a physical therapist, chiropractor, or physician of osteopathy performs deep soft tissue therapy for possible pain relief and/or increased joint mobility.
The basic building component of the spinal column. It is composed of two vertebrae, a disc, muscles, ligaments, nerves, intervertebral foramina and facet joints. Vertebral motion segments, along with the sacrum and coccyx, link together to form the spinal column.
Specialized fibers composed of bundles which can shorten and lengthen. Muscles attach to bone via tendons and function to provide movement. Specialized muscles also act to hold the body erect against the pull of gravity.
Medications that reduce contractibility of muscle fibers, which in turn may relieve some types of muscle spasms.
A pathologic condition that causes pressure on nerves with possible nerve damage resulting in pain, numbness, and/or weakness. Most common causes of nerve compression include disc herniations, facet cyts, and bone spurs (osteophytes).
A set of impulse-carrying fibers that connect the brain and the spinal cord to other parts of the body. Nerves transmit impulses to and from the brain to organs and extremities.
Nothing by mouth. No food or liquids. Patients are often made NPO at midnight the night before their surgery.
The inner portion of the disc made of cartilage that looks and feels like crab meat. It is surrounded by the annulus fibrosus.
Nurse Practitioner (NP)
An allied health care professional who provides medical care and treatment under the guidance of the attending physician.
Occupational Therapist (OT)
A person who practices occupational therapy and is licensed, registered, certified or otherwise regulated by law to do so.
Orthopedic Spine Surgeon
An orthopedic physician who specializes in the evaluation and surgical treatment of spinal conditions. Based on the history, physical examination and test results, the surgeon will make recommendations as to whether or not a patient’s condition can be helped with surgery. Orthopedic spine surgeons have undergone additional training in a spine fellowship in addition to their orthopedic residency.
A disorder characterized by abnormal loss of bone, occurring most frequently in postmenopausal women, sedentary or immobilized individuals, and patients on long-term steroid therapy. The disorder may cause pain, especially in the low back, pathologic fractures, loss of stature, and various deformities.
A surgery that does not require an overnight stay in a medical facility following surgery. Patients are able to be discharged to home the same day of surgery. Also called same-day surgery or day surgery.
PACU (Post Anesthesia Care Unit)
An area in a surgery center where patients recover from general, regional, and/or local anesthesia.
A drug that relieves pain. Narcotic analgesics act on the central nervous system and may alter a patient’s pain perception. Non-narcotic analgesics, used for mild to moderate pain, do not alter a patient’s pain perception (e.g., aspirin, Tylenol).
The part of a vertebra between the lamina and pedicle. Stress fractures can occur in this location creating a “pars facture” (spondylolysis). If the bones separate, it can lead to a spondylolisthesis.
PCA (Patient Controlled Analgesia)
A system connected to an IV which allows the patient to administer pain medication that is within the parameters prescribed by the physician. By pushing a button, medication can be released into the bloodstream for immediate pain relief.
A portion of bone in a vertebra that connects the body of the vertebra to the facet joints, transverse processes, laminae, and spinous process. The pedicle makes up a portion of the spinal canal. When placing screws in the spine for a fusion, screws are often placed thru the pedicle for strong fixation.
Of, or pertaining to, the outside, surface or surrounding area of an organ or other structure.
Physical Therapist (PT)
An allied health care professional licensed to assist in the examination, testing, and treatment of patients with orthopedic and spinal conditions. He or she can evaluate the patient’s spine, teach body mechanics and exercise, and make recommendations to the physician regarding future treatment needs.
A specialty that treats impairments and promotes mobility, function, and quality of life through examination, diagnosis, prognosis, and physical intervention.
Physician Assistant (PA)
An allied health care professional who helps care for patients in clinic and assists in surgery.
PLIF (Posterior Lumbar Interbody Fusion)
A surgical procedure in which graft material is inserted into the disc space from the back of the lumbar spine (posterior). This is done in order to fuse two vertebrae together.
The rear or back part of a structure.
Protrusion (of Disc)
A specific type of herniated disc in which a large amount of disc material breaks through the outer rings of the annulus into the spinal canal, usually causing extreme pressure on nerve(s). In this type of herniation, the base of the herniation is larger than the tip. However, the herniated fragment is still in contact with the intact portion of the nucleus pulposus.
An incomplete fusion with lack of bone growth consolidation. X-rays may show motion and poor bone graft consolidation where a fusion was attempted. Broken hardware such as screws may also be seen. Patients may experience pain from this condition. This is also commonly called a nonunion or false joint. Some pateints have no symptoms from this condition.
A device used to measure a patient’s blood oxygen level while he/she are in the hospital.
Pain which travels along the course of a nerve, usually due to compression of that nerve.
A physician who specializes in radiographic medicine. He or she performs and interprets studies such as CT scans, x-rays, MRI’s, etc. They will contact your physician if there are any concerning findings.
This occurs only in men. During sex, sperm and semen go backwards into the bladder rather than out through the penis. This usually resolves several months after surgery. When permanent, sperm can be retrieved by a urologist to allow for child bearing. This condition does not interfere with erections or sexual enjoyment. This is a rare complication from spinal surgery where an anterior lumbar interbody fusion (ALIF) is peformed at L5-S1.
Pertaining to the sacrum.
The large triangular bone at the bottom of the pelvis, inserted like a wedge between the two hip bones. It moves with the last lumbar vertebra and coccyx (tailbone).
Fibrotic tissue that is vascular, pale, contracted and occurs with healing.
The largest nerve in the body arising from the sacral plexus on both sides of the spine, passing from the pelvis through the sciatic foramen, down the back of the thigh where it divides into the lower leg, ankle, and foot.
Sequestration (of Disc)
A specific type of herniated disc in which a large amount of disc material breaks through the outer rings of the annulus into the spinal canal, usually causing extreme pressure on nerve(s). In this type of herniation, the herniated fragment is completely separated from the intact portion of the nucleus pulposus.
Spinal Cord Stimulator
An electrical device surgically implanted to apply low voltage stimulation to the spinal cord to block the feeling of pain.
The word “stenosis” means narrowing in Ancient Greek. Spinal stenosis is any condition that causes narrowing of the spinal canal or foramen. This term is usually used to refer to narrowing from bone spurs, a thickened ligamentum flavum, and cysts. However, disc herniations technically can cause spinal stenosis since they can narrow the spinal canal and/or foramen.
Slippage of one vertebra over another. The word “spondy” means vertebra and the word “olisthesis” means slippage in Ancient Greek. When a vertebra slips forward in relation to the vertebra below, it is called an anterolisthesis. If a vertebra slips backwards compared to the vertebra below, it is called a retrolisthesis. A spondylolisthesis is usually caused by degenerative conditions. A spondylolysis (pars fracture) can also cause a spondylolisthesis
Defined as a defect or stress fracture in the pars interarticularis of the vertebral arch.
Referring to, or relating to, the thorax (chest) area.
A projection of bone from the vertebrae connected by muscles and ligaments to other vertebral segments. Contraction of muscles attached to the transverse processes allow for motion of our spines.
Of, or pertaining, to a blood vessel.
The individual bones of the spine. They vary in shape and mass based on the size of the person as well as functional needs and location. In all, there are seven cervical, twelve thoracic, and five lumbar vertebrae. The sacrum consists of five vertebrae which are typically fused into one bone, and the number of coccygeal bones is variable.
Electromagnetic radiation of shorter wavelength than visible light. They are produced when electrons, traveling at high speed, strike certain materials. X-rays can penetrate most substances and are used to make photographic images for diagnostic purposes, such as to diagnose degenerative discs.