Glossary of terms used
Acute This means something that has happened recently, typically within 24 hours.
Arachnoiditis This is an inflammation around nerves inside the spinal sac, which leads to scarring aroung the nerves and sticks them together or sticks them to the surface of the spinal sac. It is a common postoperative problem and usually does not cause symptoms. However, it can cause serious symptoms, usually pain, but rarely loss of neurological function.
Aspiration Aspiration means to suck out. In medical terms, it usually means putting a needle or a tube into something and sucking out the contents.
Asymptomatic This simply means without symptoms. The disease exists or an abnormal finding is present, but it is causing no symptoms.
Benign Simply means nonmalignant. It implies something that will never become a serious problem, though some benign diseases have very serious consequences. At least it means it is not likely to be malignant.
Bilateral facet block Bilateral means on both sides. The facets are the joints on the back of the spine. Block means the injection of a local anesthetic to relieve pain. Thus bilateral facet block means an injection of a local anesthetic in and around the joints of the spine to try to relieve pain temporarily.
Cervical Spine This is the neck.
Chronic Chronic means not acute, something that has been present for a long time. Usages differ greatly, but in general anything that has lasted six months or longer is called chronic.
Competency Based Education This is a concept which substitutes mastery of specific knowledge and skills for time spent in training. A good way to think about it is to say that there would no longer be class grades in the school. Instead there would be specific goals to be met. As soon as those goals are met, the student moves on. For instance, if someone is entering the seventh grade and completes all of the required knowledge by Christmas, that person then moves to the eighth grade, and if they are finished with that material by Easter, they then would move to the ninth grade. The idea of training to competence rather than requiring years in a place is a new concept in education, particularly in medical education.
CT Computerized Axial Tomography is an x-ray device that images bone very well but other structures less well. It is commonly imployed to study the bony structure of the spine. It is also used to provide accurate needle placement during nerve blocks. The CT shows exactly where the needle is located so that the most precise injections can be made.
Cyst A cyst is like a balloon. It is a structure with a very thin wall filled with fluid.
Denervation Denervation means to destroy nerves; to eliminate the nerve supply to some structure. Nerves may be cut surgically, destroyed by heat through radiofrequency devices, or deliberately injured by injection. All are denervation. Denervation just means to eliminate the nerve supply to a structure.
Diagnostic This means to make a diagnosis. Things which are diagnostic are any technique which is meant to help make a diagnosis, but not treat a problem.
Dural Ectasia The dura in the spine forms a thick sac, whcih contains the spinal fluid, spinal cord, and spinal nerves. The so-called dural sac is about the size of the spinal canal and tightly applied to the nerves as they exit the spine. In some patients, this dura is abnormally formed and is very loose and stretches easily. As it stretches, the pressure from this enlarging balloon of dura erodes the bone and gradually the sac just gets bigger and bigger, like a balloon filling with water. Since the nerves are in the sacs, pain, loss of sensation, and weakness can occur. This abnormality is common in several inherited diseases called connective tissue disorders.
EMG Electromyography, called EMG, is an electrical test done to determine nerve and muscle function. Some of the studies are done with simple electrical stimulation of nerves. These are called nerve conduction studies or nerve conduction velocity studies. These can tell you when a nerve is injured or pinched. The studies of the nerve and muscle require the insertion of very fine needles into the muscle to examine function. With these studies, the physician can usually determine if there is muscle disease, if there is nerve disease, or if there is a nerve injury, which nerves are involved.
Epidemiological or Epidemiology This is the study of large numbers of patients with a disease. Such studies examine how often the disease occurs, who has it, what the outcome of the disease is, and frequently what treatments help it.
Epidural The dural is thick membrane that surrounds the spinal cord and spinal nerves and contains the spinal fluid. It is a tube in which the spinal cord and the spinal fluid with nerves are contained. Epidural means injecting into the spine, but outside this covering and thus outside the spinal fluid.
Failed back syndrome This is a broad term that does not mean very much. It is used to describe anybody who still has symptoms inspite of surgery on the spine. We try not to use this phrase, preferring to try to define what the actual problem in the spine is.
False positive - false negative A false positive is any test that suggests someone has a problem when they really do not. A false negative is when the test fails to diagnose a disease the patient actually has.
Herniated Disc The herniated or slipped disc is a common cause of back and leg pain or, neck and arm pain. The disc is the cushion that occurs between the bones of the spine. Sometimes a piece of this cushion breaks off and slides out into the spinal canal compressing the nerve or the spinal cord. Severe pain, loss of sensation, and even paralysis can occur.
Innervations Innervation is the nerve supply to any structure. What nerves innervate means is which nerves go to that particular structure?
Instability Instability also means motion. It simply means the spine is unstable in some part. The consequence is usually pain, and there may be associated loss of sensation and loss of strength up to paralysis. Instability simply means unstable and moving abnormally.
Lumbar Spine This is the area below the last rib and above the tail bone (about at the level of the hips).
Medical hardware This is a casual term applied to all of the metal devices that are inserted in and around the spine to achieve stability and help with fusion. Any screw, plate, rod, wire, or related structure would be called hardware.
Meningocele These are sacs of spinal fluid which are birth anomalies or defects. As far as we know, patients are born with them, and they are recognized in many children because they protrude outside the body. However, meningoceles can occur in many other patients inside the body and cannot be seen from the outside. Therefore, they are not suspected until they start causing symptoms. Nerves are often trapped within them and the spinal cord can be pulled down to below its usual location by traction. Symptoms are often loss of sensation, loss of bowel and bladder control, and loss of strength and pain.
MRI Magnetic Resonance Imaging is the stardard for examining the internal body. It does not use radiation. For spinal and nerve diagnoses these devices are used because they show the soft structures better than bone. Sometimes an intravenous injection of what is called a contrast agent is necessary to help show some specific abnormality in the spine.
Nerve Block Nerve blocks are carried out with needles. It is like a dentist anesthetizing a tooth; a small needle is inserted to a specific structure, usually with CT or fluoroscopic control. A small amount of local anesthetic is injected to temporarily anesthetize the nerve. The goal is usually temporary pain relief to prove that some structure is causing the pain, or longer-lasting pain relief by injection of a medication. These procedures are done using the local anesthetic to reduce the pain. One of these blocks typically takes about 10 minutes.
Perineural This simply means around the nerve. Peri means near to or around. Perineural cysts are between the nerve and one of the fibrous layers which surrounds it.
Pseudarthrosis Pseudarthrosis is a failure of fusion or breakdown of some structure which is normally fused. It means false joint. It is principally used to describe the failure of fusion.
Gamma Knife This is a form of cobalt radiation in which all of the radiation can be focused in one place. The machine is stable and the patient’s head is moved in the machine to achieve accurate placement of the radiation.
Cyber Knife This is another kind of radiation widely applicable to structures in and around the brain and spine. It is more versatile than the Gamma Knife because the device moves to provide the focused radiation. The Gamma Knife can only be used in and around the brain. The Cyber Knife can be also focus radiation for the spine and elsewhere.
Linear Accelerator Radiation (Linnac) This form of radiation can also be focused, though not quite as precisely as the other two described. More treatments are required with this technique. This radiation is delivered in a single or multiple dose but larger areas can be covered.
All three of these techniques have their uses. It is not the one as better than another; rather that, one may be more appropriate for an individual patient than another.
Sacral This is the tailbone located between the buttocks at the base of the spine. It is usually a single piece of bone which contains the sacral nerves. This is where most Tarlov cysts occur.
Sacroiliac joint This large joint joins the pelvic bones to the tail bone.
Sealant Sealant is something that seals. In surgical terms, it usually means something which stops by sealing blood vessels, stops spinal fluid flow by sealing a leak the fluid can come through , or a sealing some other body cavity from other body parts. Fibrin sealant or glue is a commercially available product which is similar to a blood clot in composition, but without blood cells. It is made of human and cow (bovine) products. The body typically absorbs these materials over two or three weeks, but they form a permanent scar where they are placed and therefore, can provide a permanent seal.
Spinal stenosis This diagnosis means the inside of the spinal canal is too small and the nerves or spinal cord are crowded. Usual symptoms are weakness below the area of pressure, numbness of the extremities of the body below that level, and pain. Lumbar means low back, and then the legs are affected. Cervical means the neck, and when the stenosis is in the neck the entire body below that level is involved.
Spinal x-rays Simple x-rays of the spine are frequently used. These will show the bony anatomy very well and can be used when the details required of a CT are not necessary. In addition, these x-rays can be taken in different positions so that movement o the spine can be seen.
Spondylolisthesis Spondylolisthesis means slip in the spine. The spine is no longer lined up perfectly in all planes. Part of the spine has slipped off another part in some direction. Pain and pressure on nerves or spinal cord with loss of sensation and even paralysis can occur. These slips may be acute, in which case the pain and other symptoms come on immediately, or they may be chronic, occurring very slowly. Acute slips can be very dangerous while the chronic ones cause their symptoms slowly in most cases.
Steroids Steroids are potent anti-inflammatory drugs. The best known is cortisone. Many different steroids are used for injections in and around the spine, but long acting steroids which are time released (that is, released over several days) are the most common.
Therapeutic Therapeutic means to treat. Any treatment for any disease is therapeutic.
Thoracic spine This is the area from the shoulders to the last ribs.
Transforaminal The foramen is a hole between vertebrae of the spine through which nerves exit the spine, and blood vessels both enter and exit. Transforaminal means putting a needle into or near the foramen to inject a material into the spinal canal through the foramen.