Acidity

Having a pH (chemistry symbol for the potential of Hydrogen, which is a measure of the acidity or alkalinity of a solution) that is lower than 7.0

Acupuncture

Practice of inserting needles into the skin at points (Meridians) of the body to help relieve pain and treat illness

Addiction

Psychological, emotional, physical need for a drug, associated with cravings and inappropriate efforts to obtain the drug

AFGI

Abbreviation for "Aspiration &Fibrin Glue Injection" (This abbreviation is not a standardized medical abbreviation, but one that patients have used to abbreviate; it has also been called FGI, but that abbreviation is too abbreviated in that it eliminates the first part of the procedure, the aspiration of the spinal fluid, before fibrin glue is injected.) The procedure is used for treatment of Tarlov cysts by first aspirating the cerebrospinal fluid (CSF) from the Tarlov cyst(s) and then injecting fibrin glue as a sealant to occlude the neck of the cyst and prevent CSF from further refilling the cyst. This procedure is performed by an Interventional Neuroradiologist, and sometimes with the assistance of a Neurosurgeon to guide the Neuroradiologist via CT guided fluoroscopy.

Alkalinity

Having a pH(chemistry symbol for the potential of Hydrogen, which is a measure of the acidity of alkalinity of a solution) that is higher than 7.0

Analgesic

A drug or medicine given to reduce pain without resulting in loss of consciousness. Analgesics are sometimes referred to as painkiller medications. There are many different types of analgesic medications available in both prescription and over the counter types. For further information, you might wish to go to the pain dictionary in the website library.

Anterior

Before or in front of; the opposite of posterior. Anterior approach in spine surgery refers to an approach through the front of the neck or through the abdomen.

Antidepressant

A drug used to prevent or treat depression. Some anti-depressant medications are known to act also as analgesics (pain reliever meds), especially for some forms of neuralgia (nerve pain)

The available antidepressant drugs include the SSRIs or selective serotonin reuptake inhibitors, MAOIs or monoamine oxidase inhibitors, tricyclic antidepressants, tetracyclic antidepressants, and others.

The SSRIs (selective serotonin reuptake inhibitors) include:

· citalopram (Celexa, Cipramil)

· escitalopram oxalate (Cipralex, Lexapro)

· fluvoxamine maleate (Luvox)

· paroxetine (Paxil, Seroxat, Aropax)

· fluoxetine (Prozac)

· sertraline (Zoloft, Lustral)

The MAOIs (monoamine oxidase inhibitors) include:

· phenelzine (Nardil)

· tranylcypromine (Parnate)

The tricyclic antidepressants include:

· amitriptyline (Elavil, Endep)

· clomipramine (Anafranil)

· desipramine (Norpramin, Pertofrane)

· doxepin (Adapin, Sinequan)

· imipramine (Tofranil)

· nortryptyline (Pamelor)

· protriptyline (Vivactil)

· trimipramine (Surmontil)

The tetracyclic antidepressant is maprotiline (Ludiomil).

Other antidepressant drugs include:

· bupropion (Wellbutrin)

· buspirone (Buspar)

· duloxetine (Cymbalta)

· mirtazapine (Remeron, Zispin, Avanza, Norset, Remergil)

· nefazodone (Serzone)

· reboxetine (Edronax, Vestra)

· trazodone (Desyrel)

· venlafaxine (Effexor)

Antiseizure

A classification of medications that helps to prevent seizures; they also have potential benefit in treating nerve pain. Two of the most common medications used for the treatment of nerve pain are gabapentin (Neurontin) and pregabalin (Lyrica)

Antiseizure medications by chemical and brand name:

Carbamazepine, aka Tegretol

Clonazepam, Klonopin

Clorazepate, aka Tranxene

Divalproex, aka Depakote

Gabapentin, aka Neurontin

Levetiracetam, Keppra

Lamotrigine, aka Lamictal

Oxcarbazepine, Trileptal

Pregabalin, aka Lyrica

Tiagabine, aka Gabitril

Topiramate, aka Topamax

Valproate Sodium, aka Depacon

Zonisamide, aka Zonegran

Arachnoid

Middle layer of the 3 membranes (meninges) that cover the brain and spinal cord

Arachnoiditis

Arachnoiditis is a debilitating condition characterized by severe stinging and burning pain and neurologic problems. It is caused by an inflammation of the arachnoid lining - one of the 3 linings that surround the brain and spinal cord. This inflammation causes constant irritation, scarring, and binding of nerve roots and blood vessels. The predominant symptom of arachnoiditis is chronic and persistent pain in the lower back, lower limbs or, in severe cases, throughout the entire body. Other symptoms may include:

Tingling, numbness, or weakness in the legs,bladder dysfunction,severe shooting pain (which some compare to an electric shock sensation). Most people with arachnoiditis are unable to work and have significant disability. This disorder can be very debilitating, as the pain is constant and intractable.

Aspiration

Removal of fluid and cells through a needle.

Asymptomatic

Without symptoms (the prefix "a" means in the absence of or without)

Autoimmune

A misdirected immune response that occurs when the immune system goes awry and attacks the body itself. Autoimmune diseases occur when there is a progression of this process. Some autoimmune diseases are lupus, Ehler's Danlos, scleroderma, Sjogren's, Marfan syndrome.

Biofeedback

Biofeedback is an electronic means of measuring and controlling certain on-going body functions such as muscle tension, skin temperature, and heart rate, which were once thought to be "involuntary" or not under an individual's control. The development of techniques such as biofeedback makes it possible, without drugs, to gain control over these physiological functions, many of which change dramatically under stressful conditions.

Bladder

A membranous sac or receptacle for a secretion, as in the urinary bladder

Blood Patch

An epidural blood patch is a relatively simple procedure in which blood drawn from an intravenous line in the arm is injected into the epidural space in the spine. This procedure is commonly done to treat spinal headaches, usually resulting from a loss of CSF following a lumbar puncture or myelogram. This type of headache is positional in nature, usually worsened by sitting or standing and relieved by lying down. Placement of the blood forms a barrier within the epidural space to seal off the leak.

The injection is done with the patient lying on his or her abdomen. Fluoroscopy (live x-ray) is used to aid the radiologist in guiding the needle directly into the epidural space. Once the needle has reached the epidural space, a small amount of contrast dye is injected into the area to ensure proper needle placement and then the blood is injected.

Following the procedure, the patient is expected to lie flat for approximately an hour, after which time the patient is discharged with instructions to rest at home.

Bone scan

A bone scan is a test that detects areas of increased or decreased bone metabolism. The test is performed to identify abnormal processes involving the bone such as tumor, infection, or fracture. A radiotracer (a bone-seeking radioactive material) is injected into a vein, so it travels through the bloodstream. As the material wears away, it gives off radiation. This radiation is detected by a camera that slowly scans your body. The camera takes pictures of how much radiotracer collects in the bones. If a bone scan is done to see if you have a bone infection, images will be taken shortly after the radioactive material is injected, as well as 3 to 4 hours later, when it has collected in the bones. This is called a 3-phase bone scan.

Catheterize

Passage of a small catheter (tube) into a body cavity for the purpose of drainage as in catheterization or drainage of the urinary bladder, or for insertion of a contrast medium for a diagnostic test

CAT scan or CT

Computerized Axial Tomography (CAT) or CT scanning uses special X-ray technology to obtain image data from different angles around the body and then uses computer processing of the information to show a cross section of body tissues and organs. Radiologists interpreting the images can then view the organs in cross section.

Cauda equina

Cauda equina (horse's tail) is so-called because of its appearance. It is found at the lower end of the spinal cord. The spinal cord is shorter than the spinal (vertebral) canal in which it runs, ending at the approximate level of the first or second lumbar vertebra (this may vary in different people). The cauda equina contains the nerve roots from L1-5 and S1-5. Nerve roots L4-S4 join in the sacral plexus which gives rise to the largest nerve in the body, the sciatic nerve. The sacral plexus is also involved in sensory and motor nerves to and from the anal and genital regions. The nerve roots emerge in pairs from the relevant vertebral foramen (hole)

Cervical

Chiari Malformation

Chiari malformations (CMs) are structural defects in the cerebellum, the part of the brain that controls balance. When the indented bony space at the lower rear of the skull is smaller than normal, the cerebellum and brainstem can be pushed downward and protrude through the foramen magnum (the opening at the base of the skull through which the spinal cord passes). The resulting pressure on the cerebellum and the spinal cord can block the flow of cerebrospinal fluid (the liquid that surrounds and protects the brain and spinal cord) and can cause a range of symptoms including dizziness, muscle weakness, hoarseness, numbness, vision problems, headache, and problems with balance and coordination.

Clinical Trials
 

Organized studies that test the value of various treatments, such as drugs or surgery, in human beings. They are only conducted on a limited basis and with the approval of IRB (Internal Review Boards), which are committees that approve, monitor, and regulate the activities of the trials, as well as report the results. All patients involved are informed and sign permits to be involved in the clinical trials.

Coccydynia

Pain in the coccyx (tailbone) or end of the spinal column

Coccyx

Small bone at the base of the spinal column formed by four fused vertebrae; also referred to as the "tailbone"

Congenital

Present at birth

Connective tissue disorders

A disease (autoimmune or otherwise) ,such as Lupus, Ehler's-Danlos, or Marfan's that attacks the collagen or other components of connective tissue (the material between the cells of the body that gives tissues form and strength).

Contralateral

Originating in or affecting the opposite side of the body; for example, a Tarlov cyst may be present on the right side, but the patient's symptoms such as pain and paresthesias are on the left side

Contrast media

A dye or radiopaque substance used during an x-ray study to provide a contrast in density (thickness) between the tissue or organ being filmed and the media.The contrast media improves visualization of specific tissues and organs.

Cortisone

A hormone that is sometimes used as an anti-inflammatory agent

Craniosacral therapy

A treatment in alternative medicine that identifies and reduces restrictions in movement of the dural sheath and in the flow of cerebrospinal fluid as a means of restoring well-being.Biodynamic Craniosacral Therapy takes a whole-person approach to healing and the inter-connections of mind, body and spirit are deeply acknowledged. It is an effective form of treatment for a wide range of illnesses helping to create the optimal conditions for health, encouraging vitality and facilitating a sense of well-being. It is suitable for people of all ages including babies, children and the elderly, and can be effective in acute or chronic cases.

CSF

Cerebrospinal Fluid. The clear fluid that surrounds the brain and spinal cord, and acts as a shock absorber to prevent injury to them. CSF is manufactured in the ventricles of the brain. The CSF contains nutrients and proteins necessary for the nourishment and normal function of the brain; it also carries away waste products from surrounding tissues. The CSF flows between the cranium (skull) and spine to compensate for changes in intracranial blood volume. The balance between the production and absorption of CSF is critically important. The abnormal accumulation of fluid is due to a disturbance in the production or absorption of CSF, or to a blocked flow of CSF.

Cyst

Abnormal closed sac-like structure within a tissue that contains a liquid, gas, or semi-solid substance. Cysts can occur anywhere in the body and can vary in size. The outer portion of a cyst is termed the cyst wall.

Cystitis

An infection of the bladder. It causes burning sensations during urination and a frequent need to urinate. It is caused by bacteria settling in the bladder due to several reasons, including the inability to completely empty the bladder when urinating. This is called urinary retention.

DDD

Degenerative disc disease is a misnomer. A large part of many patients' confusion is that the term "degenerative disc disease" sounds like a progressive, very threatening condition. However, this condition is not strictly degenerative and is not really a disease. Part of the confusion probably comes from the term "degenerative", which implies to most people that the symptoms will get worse with age. The term applies to the disc degenerating, but does not apply to the symptoms. While it is true that the disc degeneration is likely to progress over time, the low back pain from degenerative disc disease usually does not get worse. Another source of confusion is probably created by the term "disease", which is a misnomer. Degenerative disc disease is not really a disease at all, but rather a degenerative condition that at times can produce pain from a damaged disc.

Disc degeneration is a natural part of aging and over time all people will exhibit changes in their discs consistent with a greater or lesser degree of degeneration. However, not all people will develop symptoms. In fact, degenerative disc disease is quite variable in its nature and severity.

Dependency

The situation where a patient may come to feel the absolute need for a drug (psychological dependency) or will experience withdrawal symptoms if the drug is taken away (physical dependency).

Dermatome

Dilation or dilatation

Disc/Disk

A flat round platelike structure. Discs separate the bones that make up the spinal column. They are fibrous structures filled with a pulpy, gelatinous matter(nucleus pulposus). They function as shock absorbers for the spine. Disc-related injuries to the back can be associated with deformation of the discs, including bulging and rupturing of the discs.

Discography

A diagnostic tool to determine if a disc is causing pain. Discography is usually performed in a procedure room that has equipment for X-ray imaging of the discs as the test is performed. You will be asked to lay on one side and may be rolled slightly forward on a table. Pillows can be used to help you achieve the desired position. Your skin will be wiped at the site of the injection with a cleansing antiseptic agent. Typically, the lowest two or three lumbar disc levels are injected. The health care provider may inject an anesthetic into the skin to reduce the pain of the needles passing through tissue. In some cases, antibiotics are given intravenously before and after the procedure. A needle is inserted through the skin and muscle and comes to rest on the outer layer of the disc. During the process of placing the needles, imaging studies called fluoroscopy (similar to X-ray) are used to help the health care provider see where the needles are located along the path to the disc. A second needle is passed through the first one and into the center of the disc. This process is repeated at each level that is to be injected. In some cases, the health care provider may decide to inject an additional level and will place needles at that location after the initial injections. Contrast (a liquid that shows up on X-ray), is injected into the center of each disc. If the disc is normal, the contrast remains in the center of the disc. If the disc is abnormal, the contrast spreads through the tears in the disc. As each disc is injected, you may be asked to rate the intensity of the pain that the injection causes, if any. You may also be asked if the pain is similar to your usual symptoms in terms of location and the type of pain you are experiencing. This procedure is repeated for each disc that is injected. The pain provoked by the injection should be temporary. CT scanning is often performed after disc injection. This gives your health care provider more information about the exact pattern of the spread of the contrast through or out of the disc. Widespread disc degeneration is identified by the contrast spreading throughout the disc space.

Dura mater

Literally means "hard mother" in Latin. It is the outermost, toughest, and most fibrous of the three membranes (meninges) covering the brain and spinal cord, and is usually simply referred to as dura.

Dural Ectasia (Ecstasia)

A widening of the spinal canal

Dural sheath

An extension of the dura mater that envelops the roots of spinal nerves

EMG

Electromyogram is a medical test that measures muscle response to electric nerve stimulation to the muscles; EMG is performed using an instrument called an electromyography, to produce a graphic record of the nerve stimulation to muscles. "Myo" is a medical term meaning muscle.

Epidural

Outside the dura, which is the outermost, toughest, and most fibrous of the three membranes (meninges) covering the brain and the spinal cord.

ESI

Epidural Steroid Injection

An epidural steroid injection places a powerful anti-inflammatory medication directly around the spinal nerves. To administer the epidural steroid injection, your doctor will have you lie flat, face down, on an x-ray table. Using the x-ray to visualize the location of the tip of the needle, your doctor will guide the needle to an area very near to the spinal nerves, called the epidural space. Using the x-ray improves the chance the medication will be given in the proper location. The epidural steroid injection lasts about 15 minutes, and light sedation may be used if needed.

Epidural steroid injections may be given by many types of physicians, including anesthesiologists, orthopedic surgeons, neurologists, interventional radiologists, and others trained in this technique. Usually a series of injections, often three, each spaced a week apart, are given. With this schedule, many patients find relief of symptoms within a few weeks. Often this helps control the inflammatory process and may provide long-lasting relief.

Side-effects from epidural steroid injections are rare, but should be discussed. These include:

Infection: Very unusual (less that 0.5%), and usually avoided by using a sterile technique.

Bleeding: Also unusual, and avoided by not performing this procedure on patients with bleeding disorders or those on blood thinning medication.

Dural Tears: Caused by piercing the sac around the spinal nerves with the needle. This usually results in a headache.

Increased Blood Sugar: Diabetics must carefully monitor their blood sugar after this or any other steroid injection.

Other side-effects are possible, and should be discussed prior to injection with the doctor performing this procedure.

Etiology

Cause

Facet

A small smooth area on a bone

Fenestration

A surgical term meaning to make an artificial opening, as in the fenestration/imbrication procedure, to create slices into a Tarlov cyst to drain the spinal fluid before packing with fat and glue (imbrication)

FGI or AFGI

A more accurate acronym is AFGI, to denote aspiration and then fibrin glue injection. Neither acronym is recognized in the standardized, universally recognized medical abbreviations. In this case it is shortened for "Aspiration &Fibrin Glue Injection". The procedure is used for treatment of Tarlov cysts by first aspirating the CSF(cerebrospinal fluid) from the Tarlov cyst(s) and then injecting fibrin glue as a sealant to occlude the neck of the cyst and prevent CSF from further refilling the cyst. This procedure is performed by an Interventional Neuroradiologist, and sometimes with the assistance of a Neurosurgeon to guide the Neuroradiologist via CT guided fluoroscopy.

Fibrin glue

Fibrin sealants are a type of surgical tissue adhesive derived from human and animal blood products. The ingredients in these sealants interact during application to form a stable clot composed of a blood protein called fibrin. Fibrin sealants are also called fibrin glues.

Filum

This is a thin piece of tissue that comes from the end of the spinal cord and goes to the coccyx (tail bone). It is also referred to as "filum terminale". Sometimes there is too much fat in the filum, or the filum is too tight; both of these things can cause a tethered cord.

Foramen

Hole or opening

Foramen magnum

Opening of the occipital bone (at the base of the skull) through which the spinal cord passes from the brain

Fluoroscopy

A type of medical imaging that shows a continuous x-ray image on a monitor, much like an x-ray movie. It is used to diagnose or treat patients by displaying the movement of a body part or of an instrument or dye (contrast agent) through the body.

Herpes Simplex Virus

Herpes simplex virus type 1 (HSV-1) is usually associated with infections of the lips, mouth, and face. It is the most common herpes simplex virus and is usually acquired in childhood. HSV-1 often causes lesions inside the mouth such as cold sores (fever blisters) and is transmitted by contact with infected saliva. By adulthood, up to 90% of individuals will have antibodies to HSV-1. Herpes simplex virus 2 (HSV-2) is sexually transmitted. Symptoms include genital ulcers or sores. In addition to oral and genital lesions, the virus can also lead to complications such as meningoencephalitis (infection of the lining of the brain and the brain itself) or cause infection of the eye -- in particular the conjunctiva, and cornea. However, some people have HSV-2 but do not display symptoms. Up to 30% of U.S. adults have antibodies against HSV-2.

HNP

Herniated Nucleus Pulposus: medical terminology for herniated vertebral disc. The soft, fibro cartilaginous, gel-like central portion of the intervertebral disc that serves as a "shock absorber cushion" in the disc. The discs may herniate, rupture, or move out of place due to injury or strain on the discs.

IBS

Irritable Bowel Syndrome is also known as spastic colon. The signs and symptoms of irritable bowel syndrome can vary widely from person to person and often resemble those of other diseases. Among the most common are: abdominal pain or cramping, a bloated feeling, gas (flatulence), diarrhea or constipation; people with IBS may also experience alternating bouts of constipation, diarrhea, and mucus in the stool. No one knows exactly what causes irritable bowel syndrome. The walls of the intestines are lined with layers of muscle that contract and relax as they move food from your stomach through your intestinal tract to your rectum. Normally, these muscles contract and relax in a coordinated rhythm. But if you have irritable bowel syndrome, the contractions are stronger and last longer than normal. Food is forced through your intestines more quickly; however, sometimes the opposite occurs, the contractions as less strong, food passage slows, and stools become hard and dry .Some researchers believe IBS is caused by changes in the nerves that control sensation or muscle contractions in the bowel. In the case of damaged or irritated sacral nerve roots at S2, S3, this could be a problem in patients with Tarlov cysts.

IC

Interstitial cystitis (IC) is a condition that results in recurring discomfort or pain in the bladder and the surrounding pelvic region. The symptoms vary from case to case and even in the same individual. People may experience mild discomfort, pressure, tenderness, or intense pain in the bladder and pelvic area. Symptoms may include an urgent need to urinate (urgency), a frequent need to urinate (frequency), or a combination of these symptoms. Pain may change in intensity as the bladder fills with urine or as it empties. Women's symptoms often get worse during menstruation.

Imbrication

A surgical term meaning to make overlaps or layers. This procedure is used in the surgical treatment of Tarlov cysts in the process of overlapping layers of fat and glue, after the cysts have been fenestrated(sliced) and drained of spinal fluid.

Incontinence

Inability to retain urine or feces through loss of sphincter control, or because of spinal lesions or spinal nerve damage

Inflammation

A basic way by which the body reacts to infection, irritation, or other injury causing the possible symptoms of pain and swelling

Interventional Neuroradiologist

An accredited medical subspecialty centered on minimally invasive image-based technologies/procedures used to diagnosis and treat diseases of the head, neck, and spine. Abbreviated as INR

Intractable

Difficult to alleviate, remedy, or cure, as in intractable pain

Kegel

Kegel exercises are designed to strengthen the pelvic floor muscles that surround the openings of the urethra, vagina and rectum.

Laminectomy

A surgical procedure to remove a portion of a vertebra, called the lamina, under which one finds the ruptured disk that is pushing on nerves and causing pain and dysfunction. The ruptured disk is then removed. In other instances the lamina is removed because of pressure caused by bony spurs or other pathology.

Lordosis

An abnormal forward or inward curvature of the spine in the lumbar region

LP

Lumbar Puncture. Also referred to as a "spinal tap". This procedure is done for diagnostic purposes to obtain spinal fluid for lab analysis. It is also a procedure done prior to a myelogram, as a mechanism for injecting contrast material (dye) into the spinal fluid, so that anatomical abnormalities can be more clearly seen.

Lumbar

Pertains to the abdominal segment of the torso, between the diaphragm and the sacrum (pelvis) The five vertebrae in the lumbar region of the back are the largest and strongest in the spinal column.

Marfan Syndrome

Marfan syndrome is an inherited disorder of the connective tissue that causes abnormalities of the patient's eyes, cardiovascular system, and musculoskeletal system. Marfan syndrome is sometimes called arachnodactyly, which means "spider-like fingers", since one of the characteristic signs of the disease is disproportionately long fingers and toes. It is estimated that one person in every 3000-5000 has Marfan syndrome, or about 50,000 people in the United States. Marfan syndrome is one of the more common inheritable disorders.

Marfan syndrome affects three major organ systems of the body: the heart and circulatory system, the bones and muscles, and the eyes. The genetic mutation responsible for Marfan syndrome was discovered in 1991. It affects the body's production of fibrillin, which is a protein that is an important part of connective tissue. Fibrillin is the primary component that allow tissues to stretch repeatedly without weakening. Because the patient's fibrillin is abnormal, his or her connective tissues are looser than usual, which weakens or damages the support structures of the entire body.

The most common external signs associated with Marfan syndrome include excessively long arms and legs, with the patient's arm span being greater than his or her height. The fingers and toes may be long and slender, with loose joints that can be bent beyond their normal limits. This unusual flexibility is called hypermobility. The patient's face may also be long and narrow, and he or she may have a noticeable curvature of the spine. It is important to note, however, that Marfan patients vary widely in the external signs of their disorder and in their severity; even two patients from the same family may look quite different. Most of the external features of Marfan syndrome become more pronounced as the patient gets older, so that diagnosis of the disorder is often easier in adults than in children. In many cases, the patient may have few or very minor outward signs of the disorder and the diagnosis may be missed until the patient develops vision problems or cardiac symptoms.

Massage

Systematic, scientific manipulations of body tissues with the hands to relieve pain and reduce swelling, relax muscles, and speed healing after strains and sprains. It has been used for more than 3,000 years by the Chinese. Early in the 19th century, the Swedish physician Per Henrik Ling (1776 – 1839) devised a massage system for joint and muscle ailments, which were later, extended to relieve deformities of arthritis and re-educate muscles following paralysis. Manipulations include light or hard stroking, compression (kneading, squeezing, and friction), and percussion (striking with the edges of the hands in rapid alternation).

Massage for the patient with Tarlov cysts should be a gentle massage and particularly around the sacral area.

Meninges

The three layered membranes (pia mater, arachnoid mater, and dura mater) that surround the brain and spinal cord

Diagram of Vertebra, Meninges and Spinal cord

Meningocele

A protrusion of the meninges through an opening in the vertebral column. A meningocele contains only cerebrospinal fluid and no neural tissue.

MRI

Magnetic Resonance Imaging. MRI is a diagnostic imaging tool that produces detailed images of the human body without ionizing radiation or X-rays. These images are created using a large magnet, radio waves and computers.

MRN

Magnetic Resonance Neurography is the imaging of nerves through the use of magnetic resonance equipment. But MR neurography is more than just placing a person underneath an MR machine and taking a picture; it is a patented process that requires specific MR equipment and patented configurations, skilled personnel to perform the imaging, computer-aided visual enhancements, and trained neuroradiologists and neurosurgeons to "read" (or knowledgeably interpret) the scans to properly identify issues and provide diagnoses and recommended courses of action.

Myelogram

A myelogram is a special x-ray examination to study the spinal canal, spinal cord and the area surrounding it, which is called the subarachnoid space. The procedure involves the injection of contrast material or dye into the spinal canal. A myelogram can identify abnormalities of the spinal cord, the spinal canal within which it sits, and the spinal nerve roots connected to it. Myelography is often performed when other exams such as computerized tomography (CT) scans or magnetic resonance imaging (MRI) have not provided enough information for an accurate diagnosis to be made.

Narcotic

An addictive drug, such as opium, that reduces pain, alters mood and behavior, and usually induces sleep or stupor. Natural and synthetic narcotics are used in medicine to control pain.

NCV

Nerve conduction velocity (NCV) is a test that determines the speed of conduction of impulses through a nerve. The nerve is stimulated, usually with surface electrodes, which are patch-like electrodes placed on the skin over the nerve at various locations. One electrode stimulates the nerve with a very mild electrical impulse. The resulting electrical activity is recorded by the other electrodes. The distance between electrodes and the time it takes for electrical impulses to travel between electrodes are used to calculate the nerve conduction velocity.

Nerve Blocks

The injection of a nerve numbing substance around a group of nerves (plexus or ganglion) that cause pain to a specific organ or body region. There are different types of nerve blocks used for different purposes: "Therapeutic" nerve blocks are used to treat painful conditions. They contain local anesthetic that can be used to control acute pain. "Diagnostic" nerve blocks are used to determine sources of pain; these blocks typically contain an anesthetic with a known duration of relief. "Prognostic" nerve blocks predict the outcomes of given treatments. For example, a nerve block may be performed to determine if more permanent treatments (such as surgery) to block the activity of a nerve would be successful in treating pain. The medications that are injected include local anesthetics, steroids, and opioids.

Nerve root

The start of the nerve as it leaves the spinal cord and passes through the left and right foramen to serve an area of the body. Diagram shows the Sacral nerves at S2, S3, and S4 that effect the intestines, bladder, and reproductive organs.

Neuralgia

Nerve Pain

Neuritis

Inflammation of a nerve

Neurogenic

Originating from nerve tissue

Neuropathy

The name given to a group of disorders involving nerves. Symptoms range from a tingling sensation or numbness in the toes and fingers to paralysis.

Neuropathic pain

Pain initiated or caused by a primary lesion or dysfunction in the nervous system. It is characterized by spontaneous pain described as burning, cramping, constant

NR

Neuroradiologist - A physician who specializes in the branch of radiology that deals with the nervous system

NS

Neurosurgeon. A physician who has specialized in surgical procedures involving brain, spinal cord and nervous system.

NSAID

Non Steroidal Anti-Inflammatory Drug - There are 2 types of prescription and OTC (over the counter) NSAIDs

Traditional NSAIDs include the following:

Diclofenac (brand names: Cataflam, Voltaren)

Etodolac (brand name: Lodine)

Fenoprofen (brand name: Nalfon)

Flurbiprofen (brand name: Ansaid)

Ibuprofen ( brand names: Advil, Motrin)

Indomethacin (brand name: Indocin)

Ketoprofen (brand names: Orudis, Oruvail)

Meclofenamate

Meloxicam (brand name: Mobic)

Nabumetone (brand name: Relafen)

Naproxen (brand names: Anaprox, Naprelan, Naprosyn)

Oxaprozin (brand name: Daypro)

Piroxicam (brand name: Feldene)

Sulindac (brand name: Clinoril)

Tolmetin (brand name: Tolectin)

COX-2 inhibitors include celecoxib (brand name: Celebrex)

NTD

Neural tube defect; defects in the spinal cord ranging from conditions such as spina bifida, tethered cord, myelomeningocele

Opiate

Any drug containing or derived from opium

Osteoporosis

A decrease in bone mass and bone density and an increased risk and/or incidence of fracture

Pain

A sensation in which a person experiences discomfort, distress, or suffering due to provocation of sensory nerves. Chronic pain is defined as pain that lasts longer than 3 months.

Pain management

Pain management  is the discipline concerned with the relief of pain.

Acute pain, such as that which occurs with trauma, often has a reversible cause and may require only transient measures and correction of the underlying problem. In contrast, chronic pain results from conditions that are difficult to diagnose and treat, and that may take a long time to reverse. Some examples include cancer, neuropathy and referred pain. Pathways are set up to continue to transmit the sensation of pain even though the underlying condition or injury that originally caused pain has been healed. In such situations, the pain itself is frequently managed separately from the underlying condition of which it is a symptom, or goal of treatment is to manage the pain with no treatment of any underlying condition , if the underlying condition has resolved or if no identifiable source of the pain can be found.

Pain management generally benefits from a multidisciplinary approach that includes pharmacologic measures (analgesics such as narcotics or NSAIDs and modifiers,such as tricyclic antidepressants or anticonvulsants), non-pharmacologic measures (such as interventional procedures, physical therapy and physical exercise, application of ice and/or heat), and psychological measures (such as biofeedback and cognitive therapy).

Pain management practitioners come from all fields of medicine. Most often, pain fellowship trained physicians are anesthesiologists, neurologists, physiatrists or psychiatrists. Some practitioners focus more on the pharmacologic management of the patient, while others are very proficient at the interventional management of pain. Interventional procedures typically used for chronic back pain  include: epidural steroid injections, facet joint injections, neurolytic blocks, Spinal Cord Stimulators (SCS) and intrathecal drug delivery system implants, etc. Over the last several years the number of interventional procedures done for pain has grown to a very large number

Paresthesia

An abnormal sensation, such as numbness, tingling, prickling, burning, or creeping on the skin that has no objective cause. Paresthesia is the usual American spelling and paraesthesia the preferred English spelling. Pronounced par·es·the·sia. From the Greek para (abnormal) + esthesis (feeling) = an abnormal feeling.

Pathology

The scientific study of the nature of disease and its causes, processes, development, and consequences

Perineural

Around a nerve or group of nerves

Peritoneal

Having to do with the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen)

pH

A chemistry symbol for the potential of Hydrogen, which is a measure of the acidity or alkalinity of a solution. Solutions with a pH less than seven are considered acidic, while those with a pH greater than seven are considered basic (alkaline).

PHN

Post Herpetic Neuralgia – Medical term for an eruption of the herpes zoster virus that has been lying dormant in the nervous system. It is more commonly referred to as "shingles". The lesions of shingles usually appear around the lower trunk/waistline and can be very painful.

Pia mater

The delicate and highly vascular innermost layer of the three meninges (membranes covering the brain and spinal cord) It is a translation from latin meaning "tender mother".

Piriformis (muscle and syndrome)

The piriformis muscle is flat, pyramid-shaped, and oblique (slanted). This muscle originates to the anterior of the S2-S4 vertebrae, the sacrotuberous ligament, and the upper margin of the greater sciatic foramen. This muscle passes through the greater sciatic notch and inserts on the superior surface of the greater trochanter(bony bump) of the femur(large bone in the upper leg). With the hip extended, the piriformis muscle is the primary external rotator; however, with the hip flexed, the piriformis muscle itself becomes a hip abductor (Muscle which when activated, normally moves an extremity or limb away from the body). Piriformis syndrome is pain in the hip, buttocks, or thigh. It is caused by pressure on the piriformis muscle in the hip. The pain is a deep ache and gets worse with exercise or sitting for long periods. In 10% of the population the sciatic nerve passes through the piriformis instead of under it as normal. Conditions which cause the muscle to become short and contracted increase the nerve compression. Not all cases are due to the nerve passing through the muscle.

Posterior

Toward the rear or back; opposite to anterior

Prognosis

The probable outcome of a disease

Radiculopathy

The irritation of a nerve root; radiculopathies can cause pain and/or neurologic deficits

Resection

A partial excision or cutting off of a part surgically

Residual

That which is left, as in "residual urine" This can occur with inability to empty the bladder due to nerve damage; it increases the incidence of cystitis (bladder infection).

Retention

Holding back…as in the inability to urinate or empty the bladder, requiring catheterization; one cause is involvement of damaged or irritated nerve pathways to the bladder.

Sacral Nerve Root

Refers to the 5 pair of nerve roots which branch off of the sacrum. The spinal cord can be divided into segments according to the nerve roots that branch off of it. Nerves along the spinal cord consists of 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 1 coccygeal. The nerve roots run through the bony canal, and at each level a pair of nerve roots exit from the spine on the left and right side. These nerve roots are the most prevalent areas for the Tarlov cysts to form. The spinal canal extends into the sacrum and the sacral nerves exit the canal through bony foramina, ending in a bundle resembling a horse's tail and called "Cauda equina".

Sacrum

The sacral spine or sacrum refers to the large irregular and inverted triangular shaped bone made up of the five fused vertebrae below the lumbar region.

Sciatica

Low back pain and leg pain that usually travels along the path of the large sciatic nerve, from the lower back down the back of the leg. This pain can be felt when a nerve root in the lower spine that helps to form the sciatic nerve is pinched or irritated. One or more of the following sensations may occur as a result of sciatica:

· Pain in the buttock or leg that is worse when sitting

· Burning or tingling down the leg

· Weakness, numbness or difficulty moving the leg or foot

· A constant pain on one side of the buttock

· A shooting pain that makes it difficult to stand up

Scoliosis

A curving of the spine in which the spine curves to the side and away from the midline.

SCS

Spinal Cord Stimulator- In this therapy, electrical impulses are used to block pain from being perceived in the brain. Instead of pain, the patient feels a mild tingling sensation. A small wire (called a lead) connected to a power source is surgically implanted under the skin. Low-level electrical signals are then transmitted through the lead to the spinal cord or to specific nerves to block pain signals from reaching the brain. Using a magnetic remote control, you can turn the current on and off, or adjust the intensity. The sensations derived from the stimulator are different for everyone; however, most patients describe it as a pleasant tingling feeling.

Shingles

An acute infection caused by the herpes zoster virus, which is the same virus that causes chickenpox. The virus remains dormant in nerve roots for many years following chickenpox, and can reactivate causing tremendous pain along the nerve roots, primarily those around the waistline and lower trunk of the body. Shingles are also referred to as post herpetic neuralgia (PHN).

Shunt

A cerebrospinal fluid shunt is a system of valved tubes/catheters. It diverts cerebrospinal fluid from the subarachnoid space into another part of the body to drain it and prevent damage to the brain. In the case of Tarlov cysts, the shunt is to divert CSF away from the cyst and to prevent CSF pressure from increasing. The upper end of the shunt is placed in the subarachnoid space in the lumbar part of the spinal column; the lower end drains fluid into the peritoneum (the membrane that lines the walls of the abdominal cavity). This shunt is called a lumboperitoneal shunt.

Spina Bifida

A congenital defect with failure of closure of one or more of the vertebral arches, which may be associated with malformations of the spinal cord, nerve roots, lipomas, and congenital cysts. These malformations range from mild to severe, including complete failure of neural tube and spinal cord fusion, resulting in exposure of the spinal cord at the surface of the skin. The open form is called "Spina Bifida Cystica" and the closed form is "Spinal Bifida Occulta".

Spina Bifida Occulta

The closed form of malformation of the spinal cord; a congenital defect of the neural tube due to failure of the vertebral arch to close

Spinal cord

A large bundle of nerve fibers located in the back that extends from the base of the brain to the lower back, the spinal cord carries messages to and from the brain and the rest of the body.

Spinal nerves

Any of the nerves that arise in pairs from the spinal cord. There are 31 pairs of spinal nerves in the human body.

Subarachnoid

The space between the arachnoid and the pia mater (2 of the 3 meninges) covering the spinal cord

Symptomatic

With symptoms or concerning symptoms that cause changes in body function or process

Symptomatology

The combined symptoms of a disease

Syringomyelia

Syringomyelia (sear-IN-go-my-EEL-ya) is a disorder by which a cyst forms within the spinal cord. This cyst, called a syrinx, expands and elongates over time, destroying the center of the spinal cord. Since the spinal cord connects the brain to nerves in the extremities, this damage results in pain, weakness, and stiffness in the back, shoulders, arms, or legs. Other symptoms may include headaches and a loss of the ability to feel extremes of hot or cold, especially in the hands. Each patient experiences a different combination of symptoms. Magnetic resonance imaging (MRI) has significantly increased the number of syringomyelia cases that are diagnosed in the beginning stages of the disorder. Signs of the disorder t