Revolutionizing Spine Care…Changing Lives


Occurring over a short time or rapidly changing. Often refers to pain that occurs suddenly.


Tissue for transplant, in the case of spine surgery, usually bone. Allografts are from human cadaver donors.

Annulus Fibrosis

The outer portion of the intervertebral disc, made of layers of collagen fibers that lie in circumferential layers around the nucleus pulposus.


The front side of the body. The anterior approach in spine surgery refers to an approach through the front of the abdomen or the front of the neck.

Anterior Interbody Fusion (AIF)

A surgical procedure involves the replacement of some or all of the disc with a bone graft through an anterior approach. This technique is used commonly in the cervical spine to treat degenerative disc disease and herniated nucleus pulposus (HNP). This technique is also used in the lumbar spine to accomplish a fusion in many situations.

Anterior Lumbar Interbody Fusion (ALIF)

Anterior interbody fusion is done in the lumbar spine.


Inflammation of the arachnoid membrane (one of the coverings of the spinal cord/brain) can lead to scarring. This condition may be identified after surgery or myelograms were done many years ago. Some patients who have arachnoiditis have persistent pain.


A commonly used term that describes a disorder that causes inflammation and pain of the joints. Inflammation of a joint.

Arthroscopic Microdiscectomy (AMD)

A minimally invasive method of discectomy.


A tissue graft taken from the patient and used in another place for fusion in the same patient. Typically, in spine surgery, bone is taken from the patient’s iliac crest (part of the pelvis) or taken from the area already being operated on and is moved to the area where fusion is desired.

Back School

A class or course in body mechanics includes proper lifting techniques and back care aimed at the prevention of back pain.


The use of auditory and visual signals reflecting a patient’s muscular activity to allow the patient to facilitate or extinguish a muscle action. In patients with low back pain, the objective is to reduce pain by reducing muscle tension.


Bone morphogenetic protein. Biologic material that enhances bone growth.

Bone Graft

The bone used in fusion surgery (either from the patient or from a donor) to promote spinal fusion.

Bone Growth Stimulator

An electromagnetic device worn or implanted to promote bone growth in cases where bone healing may be delayed. It may be used to enhance the fusion in patients at higher risk for difficult healing, such as smokers.

Cauda Equina

The collection of nerve roots in the lumbar spine that comes off the end of the spinal cord and travel to the lower extremities and pelvis. Controls the legs as well as bowel and bladder function.

Cauda Equina Syndrome (CES)

Loss of bowel and bladder control (incontinence or difficulty emptying) and numbness in the groin and saddle area of the pelvis, associated with weakness of the lower extremities and pain. This condition can be caused by abnormal pressure on the bottom-most portion of the spinal canal and spinal nerve roots, related to either bony stenosis or a large herniated disc. This is often a surgical emergency.


Neck or related to the neck.


Injection of chymopapain (papaya-based or other enzymes) into a herniated disc to reduce pressure.


Persistent or lasting a long time, and in the case of back pain, referring to conditions lasting longer than three months.


Pain or weakness in the legs that occurs after walking. May be due to nerve compression or to obstruction in the blood supply to the legs.


The bottom-most bone of the spine; the tailbone.


Medications administered either orally or by injection for severe pain in the low back, neck, or radiating pain. Useful for their powerful anti-inflammatory effect. Corticosteroids of different types are used frequently in medicine to treat a variety of conditions thought to be caused by inflammation.


Cerebrospinal fluid. Fluid filling the dural sac and providing nourishment and protection for the spinal cord and brain.


Computerized tomography. A diagnostic imaging test. In CT scanning, X-rays are employed to generate cross-sectional images. The high-resolution CT scan provides excellent viewing of bones and bone spaces. CT scanning does not image soft tissues as well. Also known as a CAT scan.


Doctor of Chiropractic Medicine.


Demineralized bone matrix. Donor bone that has had the calcium removed. Used to enhance bone growth.


(1) Surgical removal of pressure from nerve roots or spinal cord, accomplished by enlarging the spinal canal. (2) Traction used by chiropractors or physical therapists to relieve pressure on nerves.

Degenerative Disc Disease (DDD)

A catch-all term to describe degenerative changes in the disc(s) caused by aging or wear and tear.


Therapeutic elevation of the temperature of deep tissues by means of high-frequency shortwaves or microwaves.


The intervertebral disc is a combination of strong connective tissues that hold one vertebra to the next and act as a cushion and a hinge between the vertebrae. It is made of a tough outer layer called the “annulus fibrosus” and a gel-like center called the “nucleus pulposus.”


A surgical procedure in which part of a herniated disc is removed. The goal of the surgery is to make the herniated disc stop pressing on and irritating the nerves. This compression can cause pain and weakness. These procedures may be done as an open procedure, with a microscope, or via a minimally invasive method.


Inflammation or infection of the disc.


The injection of dye into the nucleus of an intervertebral disc used to determine the source of a patient’s pain. During the injection, the physician performing the procedure asks the patient if the injection generates pain similar to his/her “usual pain.” Discographic images are generated from plain radiographs and computed tomography (CT) imaging.


Doctor of Osteopathic Medicine.


Dorsal root ganglion. The very sensitive part of the nerve root located just outside of the spinal canal.

Electromyography (EMG)

A test used to determine the function of the peripheral nerves and nerve roots, involving the placement of tiny needles in muscles and an electrical stimulus that can be monitored for changes that reflect the function of the connection between the nerve and muscle. This test is usually performed in conjunction with a nerve conduction velocity study (NCV).

Endoscopic Discectomy

A minimally invasive method of discectomy done with an endoscope, which is a special device that allows visualization of the disc from the inside. See Discectomy.

Epidural Steroid Injection (ESI)

Injection of corticosteroid medications into the epidural space (the area around the spinal fluid sac) to reduce inflammation of the nerve and disc and provide pain relief.


The science that studies interaction between humans and their environment, including jobs, tasks, equipment, and tools. Using this information, work environments can be adjusted to improve safety, health, quality, comfort, and productivity in the workplace.

Facet Injection

Injections of steroids and local anesthetic into the facet joints to determine if they are a source of pain or to reduce pain and inflammation. Also called zygapophysial joint injections.

Facet Joints

The bones of the spine are connected in the front of the spine by intervertebral discs and in the back by paired joints. These paired joints are commonly called “facet joints,” “zygapophysial joints” or “z-joints.” The facet joint has a capsule, smooth articular cartilage, and joint fluid just like the knee or hip joints.


Food and Drug Administration. U.S. government consumer protection agency that promotes and protects public health by helping safe and effective products reach the market in a timely way and monitoring products for continued safety after they are in use by the consumer.

Fluoroscopic Guidance

Use of live radiographic imaging to assist in the placement of instrumentation for some diagnostic and surgical procedures.


A surgical procedure performed to eliminate movement of painful or unstable spinal motion segments. Spinal fusion is often used to treat degenerative disc disease but is also used to treat scoliosis, kyphosis, fractures, and tumors. Bone is grafted across a motion segment of the spine where it grows together, uniting two or more bones into one.

Herniated Disc

With age, the center of vertebral discs may start to lose water content, making the disc less effective as a cushion and allowing the disc’s center to fragment. The fragments can then displace through a crack in the outer layer of the disc. When one of these fragments of the center of the disc has moved into the outer fibers of the disc or beyond, it is considered herniated or ruptured. Most disc herniations in the lumbar spine occur in the bottom two discs, just below the waist. A herniated disc may cause back pain or, more commonly, can press on a nerve root in the spinal canal causing pain, numbness, tingling, or weakness of the leg called “sciatica.” Also known as a slipped or ruptured disc, or herniated nucleus pulposus (HNP). Also commonly occurs in the neck (resulting in arm pain or weakness) and rarely in the thoracic portion of the spine.

Herniated Nucleus Pulposus (HNP)

See Herniated Disc.


Intradiscal electrothermal therapy. A percutaneous procedure done on damaged discs to relieve pain by inserting a catheter into the disc, then heating it for a short time.


When vertebrae move beyond their normal range of motion. This may result in back or leg pain.

Intervertebral Cage

A type of instrumentation surgically placed into the disc space to promote fusion.


Intravenous, placed into a vein.


Procedure to repair osteoporosic fractures, in which the fracture is returned to a position closer to normal using a balloon, and the cavity created by the balloon is filled with medical cement.


A curve of the spine in which the spine bends forward. A “hunchback” is one example of excessive kyphosis.


Licensed Professional Counselor.


Licensed Vocational Nurse.


Surgical procedure removing the back portion to a vertebra (the lamina) to relieve pressure on the spinal cord and nerve roots.


Surgical procedure removing a small bony portion of shingle-like posterior elements (lamina) that protect the neural canal to relieve pressure on the nerve roots. Also used to gain access to the disc space from behind.


Low back pain.


A tough gristly band of fibrous connective tissue that joins bones to bones and serves to limit or guide motion.


The curve of the spine in which the spine bends backward. “Swayback” is an example of this.


Lower back; lowest five mobile bones of the spine.


Medical Assistant.


Medical Doctor.


A surgical procedure performed with a microscope or magnification via a small incision used to remove herniated disc material.

Minimally Invasive Surgery (MIS)

Surgery done through multiple small incisions rather than a larger, open procedure. The goal is to relieve a patient’s symptoms while doing less damage and allowing faster healing.


Magnetic resonance imaging. A diagnostic imaging test. MRI clearly images soft tissues such as the intervertebral disc and neural structures as well as bones. A very sensitive and specific spinal imaging test.


Spinal cord inflammation.


Spinal cord disorder that commonly causes weakness in the lower extremities and spasticity in the upper extremities that may be the consequence of spinal stenosis, particularly in the cervical spine, or an injury to the spinal cord.

Myofascial Pain Syndrome (Also Referred to as myositis, Myofascitis, Myofibrositis, Myelofibrosis, Fibromyalgia)

A condition caused by damage to soft tissue (muscles, tendons, ligaments). Damaged soft tissue can lead to this common but complex problem sometimes characterized by painful muscle knots called “trigger points.”


Nurse practitioner. Registered nurse with additional education and training.



Nerve Conduction Studies

Tests of peripheral nerves performed by stimulating the nerve at one point and measuring the action potential either at another point along the nerve (sensory conduction) or of the muscle innervated by the nerve (motor conduction).

Nerve Irritation

Frequently caused when a nerve is stretched or compressed or when it is irritated or inflamed by poisons, some drugs, or poor nutrition. The symptoms of nerve irritation include tingling or “pins and needles” sensations, pain, and numbness.

Nerve Root Block

Injection of corticosteroids (anti-inflammatories) and a local anesthetic onto the nerve root sleeve surrounding a nerve root.

Neurogenic Claudication

Symptoms of leg pain (and occasionally weakness) after walking or standing, relieved by sitting or spinal flexion, related to neural compression, usually spinal stenosis.


Nonsteroidal anti-inflammatory drugs. Medications also used to reduce swelling and inflammation. Examples of NSAIDs are aspirin, ibuprofen, naproxen, and a variety of prescription drugs. There are different classes of NSAID medications, including COX-1 and COX-2 inhibitors.

Nucleus or Nucleus Pulposus

The jelly-like center of the disc that sits between the vertebrae. With age, it may dry up, shrink, or be squeezed through tears in the annulus to protrude and put pressure on the spinal cord or the spinal nerves.


Drugs that treat pain by affecting pain perception without treating the underlying cause. These medications affect pain perception only and do not treat pathologic conditions. Also called narcotics. Usually habit-forming.




Bone spurs.


A condition in which the bones lose mineral content, making them porous and prone to fracture, usually age-related, in women more often than men.


Physician assistant.


Projection of bone from the vertebral body, connecting the front of the spine to the back. Helps form the ring around the spinal canal. A very strong portion of the spine, therefore a commonly used attachment point for screws in the spine.


The bony ring (formed by the sacrum, the coccyx, the iliac bones, the pubic bones, and the ligaments connecting them) that serves as a support for the spine and joints with the legs at the hips.


Passage through skin by a needle or small incision.

Percutaneous Lumbar Discectomy (PLD)

The removal of bulging disc material percutaneously through a large-bore needle inserted into the disc space. The disc material is removed using laser, cutting, sucking, or laser appliances. Also known as percutaneous microdiscectomy.

Percutaneous Nucleotomy

The removal of disc material through a large-bore needle.


Pain Management and Rehabilitation.


Polymethyl methacrylate. A material used as bone cement for orthopedic and spine surgery.


Rear. Being on the backside. In rear position.

Posterior Lumbar Interbody Fusion (PLIF)

Spinal fusion technique in which the disc is removed through the back of the spinal canal after retracting the nerves. Bone graft is then inserted in the intervertebral (disc) space, also through the back-sided incision.


The attitude or position of the body.


As necessary.

Pseudarthrosis (Variation: Pseudoarthrosis)

When a solid fusion is not obtained after fusion surgery. Not always painful.


Physical Therapist or Physical Therapy.


Registered Nurse.

Radiculopathy (Radicular Syndrome)

Impairment of a nerve root, usually causing radiating pain, numbness, tingling, or muscle weakness that corresponds to a specific nerve root.

Range of Motion

How much or how far a joint can bend. It may be active – caused by a patient’s own muscles – or passive – caused by an outside force.


Part of the pelvis just above the coccyx and below the lumbar spine. (The sacrum is actually a collection of five fused vertebrae.)

Sciatic Nerve

The largest nerve in the body that comes from the fourth and fifth lumbar nerve roots and the upper sacral nerve roots, providing the nerve supply to many of the muscles of the thigh, leg, and foot. It carries sensory information to the brain from the outside of the lower leg and the foot.


Pain, numbness, tingling in the distribution of the sciatic nerve, which travels from deep in the buttock down to the foot.


An abnormal curve of the spine when seen from the front.


Sacroiliac. The joints (one on each side) between the sacrum at the midline and the iliac wings, which form part of the pelvic ring. Often a site of referred pain and maybe a source of pain.

Soft Tissue

All tissues in the body except actual bone. Most often the term refers to muscles, tendons, ligaments, and connective tissues, along with nerves, blood, and lymph vessels.

Spina Bifida

Congenital defect of the spinal column, where a hole in the vertebra leaves the spinal cord and nerves exposed. This condition is usually identified at birth and may be treated early in life.

Spina Bida Occulta

A congenital defect of the spinal column where the lamina fails to come together completely at the midline. In this form, there are no exposed neural elements; therefore, this is usually an incidental finding without any clinical findings associated.

Spinal Cord

The large bundle of nerve fibers running from the brain to the body, and from the body to the brain, which carries messages in both directions. Part of the central nervous system.

Spinal Cord Stimulation (SCS)

Electrical impulses created by a small device implanted in the spine. Used to control chronic pain.

Spinal Manipulation

Manual therapy for symptomatic relief and functional improvement of the back in which loads are applied to the spine using short or long lever methods. The selected spinal joint is moved to its end range of voluntary motion, followed by the application of an impulse load.

Spinal Stenosis

Local, segmental or generalized narrowing of the central spinal canal by bone or soft tissue elements.


Refers to the stacked column of irregularly shaped bones called vertebrae that form the backbone and house the spinal cord.

Spondylolisthesis, Degenerative

When a vertebra slips forward over the vertebra below it as a result of arthritis of the small joints of the spine and degeneration of the discs.

Spondylolisthesis, Isthmic (or Lytic)

When a vertebra with a crack or defect in the “pars interarticularis” (where the vertebral body and the posterior elements protecting the nerves are joined) slips forward over the vertebra below it. Spondylolisthesis can be graded as I, II, III, or IV based on how far forward the vertebra has slipped.


A fracture (crack, defect) in the “pars interarticularis” where the vertebral body and the posterior elements protecting the nerves are joined. In about 5% of the adult population, there is a developmental crack in one of the vertebrae, usually at the point at which the lower (lumbar) part of the spine (L5) joins the tailbone (sacrum). May result in isthmic or lytic spondylolisthesis.

Sprain or Back Sprain

A partial or complete tearing of ligaments or other tissues near a joint. A sprain usually results when the bones that form a joint are forced beyond their normal range of motion.

Strain or Back Strain

A stretching and tearing of muscle or tendon fibers. It is sometimes called a “pulled muscle.” Strains are often the result of overexertion, such as lifting something too heavy or working a muscle too hard. They also can result from sudden or uncoordinated movement.


A spinal or other joint that is not working properly causing local nerve irritation. This not only produces pain and stiffness but through the nervous system may also cause unwanted changes in other important body functions.


A band of gristly tissue that connects a muscle to a bone near a joint.


Transcutaneous electrical nerve stimulation. A form of electrical anesthesia used to block pain perception.


Mid-upper back, area between the cervical (neck region) and lumbar (low back) spine. The portion of the spine where ribs are attached.

Total Disc Replacement (TDR)

A new surgical procedure that will replace diseased or dysfunctional discs with artificial discs. There are multiple designs of artificial discs under development at this time. Several are already FDA-approved and in use.


Pulling intermittently or continuously by mechanical or manual methods to elongate the spine.

Trigger Point

A well-localized point of tenderness. In low back problems, these points are usually located in the paravertebral areas.

Trigger Point Injections

Injection of local anesthetic with or without corticosteroid into painful soft tissues (i.e., muscles or ligaments) along the spine or over the back of the pelvis. Generally used for pain control.


Bones that make up the spine. (Vertebra: the singular form of vertebrae.)


Procedure to repair fractures related to osteoporosis, where cement is injected into a collapsed vertebra.


Commonly referred to as “neck sprain or strain,” although symptoms may have other causes. Common in car accidents. Soft tissue injury to the neck.


See Facet Joints.

Zygapophysial Joint Injections

Injections of steroids and local anesthetic into the facet joints to determine if they are a source of pain or to reduce pain and inflammation.

Zygapophysial Joints

See Facet Joints.

Leaders in Advanced Spine Procedures

To find out whether you would benefit from artificial disc surgery, make an appointment to visit Texas Back Institute in the Dallas, TX, area for an evaluation. We always reserve surgery as a last resort, so we’ll seek to relieve pain first through conservative treatments such as physical therapy and pain management. If severe pain persists and it is determined that you would benefit from surgery, we can help you determine whether artificial disc replacement is right for you.

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