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 the spine.
A method of producing pain relief or altering the function of systems in the body by inserting fine, wire-thin needles into the skin at specific sites on the body along a series of lines, or channels, called meridians; a modality that is sometimes used in back pain relief.
Beginning abruptly with marked intensity or sharpness, then subsiding after a relatively short period of time; sharp or severe.
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 a minimum of wasted energy. Examples of aerobic exercises include running, jogging, swimming and vigorous dancing or cycling.
A physician trained in the administration of medication to relieve pain during surgery, as well as one who specializes in spinal injections. He/she will perform the majority of spinal injections in addition to discograms.
A cracking of the rings inside the disc which may extend to the surface or outer layers of the annulus fibrosis. As the tear approaches the surface of the annulus, vascularization, inflammation and autoimmune responses can occur and nerve endings can be stimulated which may cause pain.
The tough, outer portion of the disc composed of multiple cartilaginous rings. These rings firmly attach to the vertebrae above and below the disc and help to hold these segments together. Approximately 70 percent of the total disc is composed of the annulus fibrosis. Although this structure is cut through during surgery involving a discectomy, it is not removed during the procedure.
The front of a structure.
Anterior Interbody Fusion
A surgical procedure involving exposure to and fusion of the spine from the front of the patient’s body. The most proper use of this type of interbody fusion is when it can be proven that pain is coming directly from inside the disc space.
Medications which prevent or delay the clotting of blood.
A substance or procedure that reduces irritation or injury to tissues of the body. Anti-inflammatory medications include Naprosyn, Clinoril, Motrin and Feldene.
A machine which monitors respiration and heart rate.
Inflammation resulting in adherence of nerve rootlets within the spinal cord covering. This is most often associated with failed-back syndrome.
A surgical procedure, usually performed as an outpatient, to excise a portion of the nucleus of a herniated disc which has been determined to be the sources of the patient’s leg pain. This procedure is performed under fluoroscopy.
An abnormal characteristic or condition in which the body reacts against constituents of its own tissues.
Blood donated by the patient prior to surgery to be used for that patient’s surgery.
An educational and training facility that teaches and promotes good back health care and body mechanics to individuals to enable them to rapidly return to normal activity and prevent further incidence of low back pain.
Bone tissue usually taken from the ileum of the pelvis or bone bank used for fusing vertebrae together in spinal surgery.
A procedure in which a concentration of radioactive substance that has an affinity for specific tissue is injected into the blood stream to enhance the images of bone activity. This exam will be ordered when the physician suspects a possible infection, recent fracture and/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 the body taking pictures. The exam takes approximately 1-1/2 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 fibrosis causing it to bulge, putting possible pressure on a nerve root.
Computed Tomography. A highly sophisticated x-ray exam which produces three-dimensional images of the body, joints, nerves, discs, bones and tissues. The scans are taken at regular intervals through the head or body as the patient lies on a table which moves slowly through the x-ray machine. The imaging data are collected by the x-ray tube moving opposite a series of detectors. The detectors transmit the data signals onto a computer where they are mathematically processed and reconstructed into images. These images are then processed by a computer and printed as an x-ray. As with all x-ray, it is important that the patient lie absolutely still throughout the procedure. The exam will take approximately one hour.
Pertaining to cartilage; a non-vascular, supporting connective tissue.
Of or pertaining to the neck or region of the neck.
A system of therapy based on the theory that a person’s health is determined in general by the condition of his/her nervous system. In most cases, treatment provided by chiropractors involves the manipulation of the spinal column. Some practitioners employ radiology for diagnosis and use physical therapy and diet, in addition to spinal manipulation. Chiropractic does not employ drugs or surgery.
A disorder or disease developing slowly and persisting for six months or longer.
A battery-powered unit which evacuates drainage from the surgical site.
A procedure involving surgical excision of bone to relieve nerve root pressure caused either by bone or soft tissue such as a disc.
Degenerative Disc Disease
A normal wear-and-tear process of the spine which occurs after multiple annular tears have developed, resulting in the nucleus pulposus drying out and losing ability to function as a shock absorber. This, in turn, causes the vertebrae to become closer together producing increased stresses 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 body mechanics and strong muscles.
In the context of spine care, relating to tests or procedures which are used to help localize and determine the source of a patient’s pain, as well as to monitor the behavior of symptoms.
Intervertebral Disc. One of the fibrous, oval-shaped wedges found between adjacent vertebrae. The tough, fibrous outer portion is called the annulus fibrosis. It is composed of multiple cartilaginous rings. These rings firmly attach to the vertebrae above and below the disc and help to hold the segments together. The inner portion is called the nucleus pulposus. In the normal, middle-aged back, it is composed of approximately 80 percent water and has a gel-like consistency. The primary functions of a disc are to absorb and transfer mechanical stresses and to provide for smooth movement. The disc also adds to stability of the spine by virtue of the fact that it operates 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. During surgery, the maximum amount of disc material that can be removed is about 40 percent. The procedure usually involves cutting through the lamina of the vertebrae at the affected level(s), and making a “window” in the annulus, through which the nucleus pulposus can be removed.
The report written by the Spine Team following surgery which summarizes the results of the procedures or surgery performed.
The injection of a contrast medium (dye)* into the nucleus (middle) of the disc, which may be done at one or more levels of the vertebrae. X-rays are taken in order to radiographically visualize the disc(s) after the contrast medium is injected. The patient lies on his/her side during the procedure which usually takes from 30 minutes to two hours to complete. The skin is numbed over the sites where the needle(s) will enter. Injection of fluid into an abnormal disc may be painful, but this helps the physician to gather important data about the back which is valuable diagnostically. A healthy disc should not be painful.
This test will determine:
- The general condition of the disc(s). It will show any tears, leaks or bulges which may be present.
- The relationship between pain and the disc(s). If the pain that is felt from the injection of the contrast media is the same pain that the patient has been experiencing, the physician will know the disc(s) is a definite contributing factor to the patient’s pain.
- The boundaries for possible surgery. This test will identify the level of the first normal disc, setting the parameters if a fusion is necessary.
- The patient must let the physician or nurse know if he/she is allergic to shellfish or iodine.
Dural Photon Study
A radiographic test which measures bone absorption; done specifically for determining osteoporosis.
A sheath containing nerve 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 transmission of the 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 impulse to the recording device. The patient is positioned lying down on his/her back on an examining table and asked to lie quietly during the test. It takes approximately a half hour to complete the test,
Abbreviation for an electromyograph. An examination of the nervous system which determines to what extent nerves and muscles have been irritated or damaged. The physician, usually a physiatrist, conducts this exam by placing small needles in various muscle groups of the affected area. A stimulus can be sent through the needle which evokes a response in the muscle. This response, recorded on a graph, measures any changes to the nerves. New and old damage can be separated and the exact nerves affected can often be identified.
Compounds occurring naturally in the brain acting upon the central and peripheral nervous system to reduce pain. Endorphin release is stimulated by aerobic exercise.
An injection which can be used as a treatment as well as a diagnostic tool to help locate the source of pain. The test is conducted in the Radiology Department by an anesthesiologist, physiatrist, or an orthopedist. The patient is also evaluated before and after the test by either the physician, nurse, or physical therapist. As the patient lies on his/her stomach, the physician anesthetizes either the lumbar or tailbone area. This procedure is similar to a novocaine injection given by a dentist. Another needle is then injected into the appropriate area and injections of various medications are given. At times, the physician may use a dye to help trace the flow of medication. The procedure takes approximately 30 minutes. The patient should alert the physician or nurse if allergic to shellfish, iodine, cortisone, or anesthetic.
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 the nerve root.
A diagnostic and therapeutic procedure done to determine how much pain is coming from the facet joints, and also to relieve pain.
The overlapping of bony projections occurring when two vertebrae are placed on top of one another. They function to guide and restrict movement of the spine. Joints are surrounded by capsules which contain fluid and fibrous tissues. The capsules provide protection and lubrication to the bony surfaces of the joints.
Referred to as methods or techniques a patient can employ to relieve painful symptoms arising from pain.
Done to determine the quality of motion in the lumbar spine. 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. Patients are asked to go to the limit of motion in both directions so that the physicians can obtain accurate information. Patients may support themselves with hands to prevent pain, if necessary. The exam takes approximately 20 minutes.
Tube placed into the bladder to drain urine.
Intervertebral Foramen (foramina pl.). The hole created when two vertebrae are placed together. As a spinal nerve branches from the spinal cord, it exits through this hole and travels to muscle.
A surgical procedure joining two or more spinal vertebrae, performed to stabilize a segment(s) of the spinal column. Bone graft is usually taken from one of the patient’s iliac crests or from a bone bank, and packed around the joint surfaces of the vertebrae being fused. Bone chips may be used alone or in conjunction with metal fixation devices.
A physical conditioning program prescribed by the physician for purposes of general strengthening and fitness.
A general term used to describe a condition in which the nucleus pulposus escapes from the annular tears and enters the intervertebral foramina. A variety of clinical symptoms can be produced depending upon the size and the location of the herniation. Pain may result from direct physical pressure or chemical irritation.
Home Exercise Program
A specific spine exercise program given to patients either by their physicians, therapists or trainers, depending upon the patient’s specific back condition and ability.
I + O
Intake and Output. Measurement of the amount of fluid a patient takes in and how much urine is put
Intravenous. A method by which a patient is fed through the vein to maintain nutrition and hydration status.
An instrument that measures the volume of inhaled air, 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. The document must be written in the language understood by the patient and at least one witness. Included in the document are clear, rational statements that describe the procedure or test, the risk to the patient, the expected benefits to the patient, the natural anticipated consequences of not allowing the test or procedure, and the alternative procedures or diagnostic aids that are available. Also required is a statement that care will not be withheld if the patient does not consent; Informed Consent is voluntary. By law, Informed Consent must be obtained more than a given number of hours or days before certain procedures are performed and must always be obtained when the patient is fully competent. The physician is responsible for giving the patient this information.
A condition in the spine which results in motion occurring between two or more vertebrae, usually the result of degenerative disease. Flexion and Extension X-rays are often helpful in making this diagnosis.
Internal Disc Disruption
A disorder in which chemical irritants released from the disc are thought to contribute to a change in the metabolism of the disc. A discogram is the only test which can be used to distinguish this problem from other abnormal back conditions. All other tests and studies are usually normal. Internal disc disruption never spontaneously subsides, distinct from degenerative disc disease which has x-ray changes over the years and can spontaneously resolve.
A physician member of the Spine Team who coordinates management of health problems a patient might have, such as diabetes, osteoporosis, high blood pressure, pain control, etc., with the patient’s spine care. He/she makes recommendations regarding a surgical or nonsurgical approach based on the patient’s overall physical exam and test results from a multi-disciplinary evaluation.
Characterized by a tendency to spread, infiltrate, and intrude, such as a procedure done with a needle, e.g., epidural block, discogram, and EMG.
Any action or skill maneuver which exerts the muscles and is performed repeatedly in order to develop or strengthen the body or any of its parts. A form of active exercise that increases muscle tension by applying pressure against stable resistance. This may be accomplished by opposing different muscles in the same individual as when a patient performs a partial sit-up and holds this position. There is no joint movement and the length of the muscle remains unchanged, but the muscle strength and tone are maintained or improved.
A form of active exercise in which the muscle contracts and causes movement. Throughout the exercise, there is no significant change in the resistance so that the force of contraction remains constant. Such exercise greatly improves joint mobility and helps to improve muscle strength and tone.
A procedure involving surgical removal of the bony arch of the vertebrae which covers the nerve and allows for exploration of the disc and foramina.
Fibrous tissue which connects bone to bone.
Technique used to turn in bed. Patients are instructed to brace the stomach muscles, and move the shoulders and hips at the same time to prevent twisting the spine. This is especially helpful for patients following spine surgery as twisting is often painful and stressful to the surgical site.
Of or pertaining to the part of the spine between the thoracic spine and the pelvis.
Magnetic Resonance Imaging. A special study to help the Spine Team obtain a diagnosis for a particular spinal problem. Images are obtained by using a high-strength magnetic field and radiowaves, which allows for high resolution of localized images of the spine without the ionizing radiation effects associated with x-rays. Patients enter a large room, lie on a sliding narrow bed, and then are placed inside a very large metal, tunnel-shaped magnet. Nothing touches the body and no sensations are felt during the test. During this time, patients will hear a repetitive, tapping noise which occurs while the machine is taking pictures from various angles. Patients are in constant communication with the people performing the exam. The entire examination should take about one hour, the actual scanning procedure occurring intermittently during this time. It is important that patients remain motionless and relaxed while the scans are obtained. Rarely, the exam can take as long as 90 minutes. Occasionally, a person may have a sense of claustrophobia while in the imager. If this cannot be tolerated, the patient is allowed to leave. Any metal sutures, screws, plates, or other metallic devices in the body will prevent the patient from having this test.
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.
Medications that reduce contractibility of muscle fibers, which in turn may relieve some types of muscle spasm.
Specialized fibers composed of bundles which have the ability to shorted and lengthen. Muscles attach to the bone via a tendon and function to provide movement. Specialized muscles also act to hold the body erect against the pull of gravity.
An x-ray film taken after the injection of radiopaque material into the spinal canal to demonstrate any distortion of the spinal cord, spinal nerves, and the subarachnoid space. This diagnostic test, though not used as frequently as in the past, is used to confirm the presence of some types of herniated discs as well as spinal cord tumors.
Nothing by Mouth. No foods or liquids.
One or more bundles of impulse-carrying fibers that connect the brain and the spinal cord with other parts of the body. Nerves transmit impulses to and from the brain to organs and extremities.
A pathologic condition that causes pressure on nerves, resulting in possible nerve damage and muscle weakness or atrophy. Modification of causative activities, such as body mechanics, often heals nerve damage caused by compression. Surgery may be required to correct more severe cases.
A physician member of the Spine Team who specializes in surgery involving the brain, spinal cord, or peripheral nerves.
Pertaining to diagnostic or therapeutic techniques that do not require the skin to be broken or a cavity or organ of the body to be entered, such as a CT Scan, MRI, or x-ray.
The inner portion of the disc which has a gel-like consistency and is surrounded by the annulus fibrosis.
A person who practices occupational therapy and who may be licensed, registered, certified or otherwise regulated by law to do so.
A rehabilitative practice which encompasses the evaluation, treatment and consultation for patients who are limited by physical injury or illness. The practice utilizes activities of daily living (such as cooking and gardening) to maximize independence, prevent disability and maintain health.
Orthopedic Spine Surgeon
Orthopedist. An orthopedic physician who is specialized in the evaluation and surgical treatment of spine problems. Based on the history, physical examination and all test results, the surgeon will make recommendations as to whether or not a patient’s condition can be helped by surgery.
A therapeutic approach to the practice of medicine that uses all usual forms of medical therapy and diagnosis, including drugs, surgery, and radiation, which places greater emphasis on the role of the relationship of the organs and the musculoskeletal system than in conventional medicine. Osteopathic physicians recognize and correct structural problems using manipulation.
A disorder characterized by abnormal loss of bone, occurring most frequently in post-menopausal women, in sedentary or immobilized individuals, and in patients on long-term steroid therapy. The disorder may cause pain, especially in the lower back, pathologic fractures, loss of stature, and various deformities.
Patient Controlled Analgesia A system connected to the IV which allows the patient to administer pain mediation that is within the parameters prescribed by the physician. By pushing a button, medication can be released into the bloodstream for immediate pain relief.
Posterior Lumbar Interbody Fusion. An infrequently used surgical procedure in which graft material is inserted into the disc space, as well as in the posterior bony spinal elements.
A drug that relieves pain The narcotic analgesics act on the central nervous system and may alter the patient’s pain perception; the non-narcotic analgesics, used for mild-to-moderate pain, do not alter the patient’s pain perception. (e.g., aspirin, Tylenol) .
A particular location of the bone within the vertebral joint complex.
Of or pertaining to the outside, surface, or surrounding area of an organ or other structure.
A member of the Spine Team who is licensed to assist in the examination, testing, and treatment of patients with low back pain. He or she can evaluate the patient’s spine, assess response from diagnostic injections, teach body mechanics and exercise, and make recommendations to the team regarding future treatment needs.
The treatment of disorders with physical agents and methods, such as body mechanics instruction, therapeutic exercises, mobilization, and manipulation.
A physician who is specialized in rehabilitative medicine. He/she assists in the evaluation of the patient and performs EMG’s and various injections. Based upon the physical exam and test results, he/she makes recommendations to the Spine Team regarding a non-surgical approach to the patient’s treatment plan.
The rear or back part of a structure.
The physician who usually first sees a patient for the care of a given health problem such as back pain. This physician may be an internist or an orthopedist.
A suspected symptomatic spinal condition with a history of fusion and signs of instability. X-rays may show motion and poor bone graft consolidation.
A type of doctor who is trained to evaluate the social and emotional dimensions of chronic spine pain. Each person’s pain experience is unique. Psychologists help by using a variety of techniques based on the best available research and consider a person’s unique values, characteristics, goals and circumstances. Most commonly psychologists use psychotherapy (sometimes called talk therapy or counseling) to help people improve their lives and feel better. The psychologist’s task is to comprehend this uniqueness in the context of the patient’s particular stage of individual and family development through one or more individual meetings. Additionally, meeting family members or the administration of psychological tests may be recommended.
Test(s) used to determine the impact of pain on a patient’s life.
Pain which radiates through a particular nerve distribution.
A physician who is specialized in radiographic medicine. This team member performs and interprets selective spinal tests such as CT scans, x-rays, discograms, myelograms, MRI’s, and injections. He/she will make recommendations to the members of the Spine Team based on interpretations of these tests.
A cutting of the roots of spinal nerves within the spinal canal; done for relief of intractable pain.
Somatosensory Evoked Potential. A non-invasive diagnostic test which assesses the levels and degree of lumbosacral nerve root involvement by stimulating specific peripheral nerves.
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 the coccyx
Fibrotic tissue that is vascular, pale, contracted, and occurs with healing.
The largest nerve in the body arising from the sacral plexus on either side, passing from the pelvis through the sciatic foramen, down the back of the thigh where it divides into the lower leg, ankle and foot.
Referring to a portion of the disc material that is separated or isolated from the interior portion of the nucleus pulposus.
Spinal Cord Stimulator
A spinal cord stimulator is an electrical device which is implanted surgically to apply low voltage stimulation to the spinal cord to block the feeling of pain.
A spinal condition in which the canal through which the nerves pass is smaller than normal, usually the result of disc degeneration. Nerves are frequently compressed as a result of the closing down of the spinal canal.
A group of physicians and ancillary health professionals involved in the multidisciplinary aspects of spine care.
The partial forward dislocation of one vertebrae over the one below it. A condition in which a fracture occurs in the pars inarticularis of the vertebrae. This often leads to a spondylolisthesis.
An exercise treatment regimen which is characterized by training the patient to find the neutral, balanced, pain-free position of the spinal segment involved. Holding the segment in its balanced, pain-free position is accomplished by the use of the abdominal, gluteal, and paraspinal musculature.
Stockings which patients may be required to wear following surgery to promote adequate blood circulation.
Transcutaneous Nerve Stimulator. A device used to reduce painful stimuli or to stimulate bowel function.
Referring to or relating to the chest area.
A projection of bone from the vertebrae connected by muscles and ligaments to other vertebral segments. This portion of the bone is often the area to which a bone graft is affixed for a spinal fusion.
Of or pertaining to a blood vessel.
The individual bones of the spine, the sizes and shapes of which correspond to functional needs and location. In all, there are seven cervical, twelve thoracic, and five lumbar vertebrae. The sacrum consists of five vertebrae which are fused into one bone and the number of coccygeal bones is variable.
The basic building component of the spinal column. It is composed of two vertebrae, a disc, muscles, ligaments, nerves, nerves, intervertebral foramina and facet joints. Vertebral segments, along with the sacrum and the coccyx, link together to form the spinal column. The spinal column is divided into five parts from head to tailbone; cervical, thoracic, lumbar, sacral, and coccygeal.
Electromagnetic radiation of shorter wave length 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 disc disease.