What is the Spine?
Specific Problems of the Spine
Summary
Chronic Pain
Controversial Cases
The Sacroiliac Joint
  Glossary

A
Ankylosing Spondylitis

Annulus
Annular Tear
B
Bone Scintigraphy

Bone Graft
Bone Scan
Bulging Disc
C
Canal

Capsule
Collapsed Disc
Compression
CT Scan
Cyst
D
Definitive Treatment

Degenerative Disc
Dehydration
Diagnostic Tests
Disc Disease
Disc
Discitis
Discal Electrotherapy
"IDET"
Discectomy
Discogram
Disc Replacement

E
Electromyogram

Epidural Steroids
F
Facet Injection

Facet Joint
Facet Osteophytes
Fracture
Fusion
H
Herniated Disc
I
Inferior Articular Process
K
Kyphosis
L

Laminectomy

Laminotomy
Lateral Recess
Ligament
Lordosis
Lumbar
M
Malignancy
MRI
Myelogram
Myelopathy
N
Nerve
P
Palliative Treatment
Pinched Nerve
Prolapsed Disc
Protruding Disc


R
Retrolisthesis
Root
Ruptured Disc
S
Sacroiliac Arthrogram
Sacroiliac Joint
Sacroiliac Fusion
Sacrum
Schmorls Nodes
Sciatic Nerve
Scoliosis
Slipped Disc
Spinal Cord
Spondylolysis
Spondylolisthesis
Spine
Spur
Stenosis:
......Central
......Foraminal
............Circumferential
............Front/Back
............Up/Down
........Lateral
........Lateral Recess
V
Vertebra
X
X-Ray

   

ANKYLOSING SPONDYLITIS
An inflammatory condition of the spine, thought to be related to Rheumatoid Arthritis where the spine becomes "ankylosed" (fused). It is thought that an immune process centering on the connecting ligaments of the spine causes them to turn to bone.

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ANNULUS

The outer constraining ligament of the discs (comes from the term annual, to go "round and round") which encompasses the nucleus, a central object of the disc. Although it contains living elements in the young person (cells), it becomes less vital, less flexible and less capable of holding water as we get older. The annulus can rupture ("Herniated Nucleus Pulposus") into the canal and is responsible fo the classic inerpretation of a "herniated disc".

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Annular Tear
Annular_Tear_LargeIn all respects, this MRI is normal with the exception of the horizontal white line denoting an annular tear. This is the tear of the outer disc ligament. This may cause either a chemical irritation (due to a spill of interdiscal contents) or compression (by direct pressure on the nerve).


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BONE SCINTIGRAPHY

See Bone Scan.

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BONE GRAFT

The harvest of bone material from the patient's body. Allograft may also be taken from another person. The success of a bone graft is determined greatly upon mechanical factors built into the operation, such as surrounding blood supply and biophysical considerations.

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BONE SCAN

The process by which bones are made radioactive by injection of small amounts of radioactive materials. Such radioactivity concentrates in areas of bone change (fractures, tumors, infections, degeneration) and may be used to highlight areas of suspected bone injury. Not very useful for demonstrating nerve compression or alignment.

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BULGING DISC

The redundancy of a normal annulus into the canal by loss of interdiscal pressure. Though traditionally considered a "normal phenomenon", a bulging disc can cause great difficulty when they encroach upon an area that Enlarge Bulging Disc is already small (because of develpomental concerns) or made small by collapsing degenerative processes. A bulge by itself is a benign process, but the secondary affects of a bulge (reflecting instability, shift, shear, and collapse) or encroachemnt (nerve pinch) can be very significant. No lesion chould be described as "normal bulging" unless it can be demonstrated a doctor's physical examination and the remaining physical findings to be truly benign. Many "bulging" discs reflect painful disc disease or nerve compression.

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CANAL

There are several canals in the spine. The central canal is the canal that passes down the posterior (back) of the spine. The foramina is the exit channels where the nerve pass from central canal to the body.

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CAPSULE

The liner of the facet joint.

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COLLAPSED DISC

A disc that has lost its ability to support the weight of the body. Discs may rupture or lose hydrostatic pressure. Under either circumstance, they lose their mechanical integrity and can no longer remain thick, healthy and effective in separating the vertebrae.

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COMPRESSION

Enlarge Compression
The process by which nerves undergo encroachment by vertebral elements, bulging discs, and facet capsule.




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CT SCAN

A so-called CAT scan or Computerized Tomography. A method of combining very small x-ray beams to create cross-sectional views of the body. It is very effective at demonstrating bony anatomy. It is used for different purposes than the MRI. For more information, visit our CT scan section in Commonly Used Tests and Exams.

For More Information: Center for Diagnostic Imaging - CT

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CYST

A "blowout" of the facet, which may also be a response to a neoplasia or an erosion within the bone. It should be closely defined as some underlying causes are not benign. Cysts, even degenerative ones, can be a factor in stenosis or nerve root compression.

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DEFINITIVE TREATMENT

A direct physical change of the offending structure. This may include a decompression (laminectomy or laminotomy). injection or steroids into the offending structure, or removal of a djsc fragment. Contrast with "palliative" which covers the symptoms, or slows the progress of the disease.

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DEGENERATIVE DISC

A damaged disc. Interruption of the annular fibers occurs with heavy use, age, or metabolic conditions specific to the patient. As the fibers tear, they cannot hold the central nucleus under control as well. The central nucleus may either rupture through the degenerating outer disc or shrivel up in place, leaving the vertebrae without proper support.



Single Level Disc DiseaseSingle Level Disc Disease
This is an example of a single level collapse. Such a change would likely cause aching or sharp catching back pain, though they can be silent.


Enlarge Multilevel Disease

Multilevel Disease-Local Herniation
This is another example of multiple level degenerative disc disease. From top to bottom we see discs that are either dehydrated, herniated, or both.



Enlarge Severe Multilevel
Severe Multilevel Disc Disease
In this case, none of the discs are convincingly herniated causing nerve compression. However, they are strikingly narrow with some shifting and settling. It would not be difficult to understand how such a back could hurt.



For More Information: A Brief Diagramatic Orientation of the Degenerative Disc.

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DEHYDRATION

The loss of water. Water is held in both the annulus and nucleus by chemicals that are secreted by the living cells of the normal youthful disc. When the chemicals (proteoglycans) are no longer produced, the disc loses its ability to hold water and loses its flexibility. This "dehydration" results in abnormal physical forces on both the remaining cellular elements (that may then die) or the annular ligament (that may lose its fibrous structure at an accelerated rate).

Enlarge Moderate DehydrationModerate Dehydration
This image demonstrates single level degenerative dehydration. It also just happens to show a herniation as well.


Severe Dehydration

Enlarge Severe DehydrationIn this case, the upper most discs are white, the middle three discs are darkened or dehydrated, and the lowest disc is white. The canal is open. Such a patient would not be expected to demonstrate signs of nerve root compression. Back pain in such a situation is not uncommon.


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DIAGNOSTIC TESTS

Studies prescribed by the doctor to define: the presence or problems (bone scan, x-ray), anatomy and its relationships (MR1, CT) or the body's physiologic responses (discography or nerve root injections). The doctor or medical practitioner may choose among the test available bases upon information availale from the physical examination, information already visible on testing, or the definition of problems that are of questionable significance.

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DISC

The flexible structure between individual vertebral bones. The disc has been described as a shock absorber, but is actually a densely wrapped ligament (the annulus) surrounding a nucleus that chemically holds water. The combinations of dense outer ligament and tensely distended disc create a semirigid structure that both keeps the vertebrae apart and allows for motion. For more information, see our section on the invertebral discs in What's the Spine?


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DISCITIS
DiscitisInfection of the disc. Refer to the diagram for explanation.






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DISCAL ELECTROTHERAPY "IDET"
The theory or method by which degenerative disc is treated with heat from a wire, the theory is that the heat either coagulates or shrinks the collagen of the disc, resulting in improved disc structure. This is highly controverisal since a large part of the treatment method relies on long periods of post-

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IDET

rest and treatment in a cast.

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DISCECTOMY

The process of removing the "disc". This usually refers to the retrieval of a fragment that compresses a nerve in the canal, but may also refer to the removal of the disc at the time fusion surgery is done.

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DISCOGRAM

Enlarge DiscogramA method of examining the disc for sensitivity (pain response) or mechanical rupture (spilling of interdiscal substance). For more information, visit our Discogram section in Commonly Used Tests and Exams.



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DISC REPLACEMENT

A method in surgical spine treatments whereby the normal flexible element is replaced by an artificial replacement flexible element. Disc replacement surgery is made technically challenging by the quality of the bone of the vertebrae and the lack of access to the vertebrae behind major neural and vascular structures, and has very limited revision opportunities.
An EMG. An electrical test measuring the ability of the nerves to conduct nerve impulses. This is a useful test when nerve loss is dramatic. Controversial utilites in situation of intermittent nerve compression.


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ELECTROMYOGRAM
An electromyogram is a test of nerve function. It works by creating electrical impulses within the nerve and then monitoring the nerves response. It measures the speed at which those impulses travel, and the response of the target tissue (the muscle). These two measurements of nerve function help determine if the nerve has been functioning properly.For more information, please visit our Electromyogram section in Commonly Used Tests and Exams.
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EPIDURAL STEROIDS

Treatment by which moderately insoluble, synthetic steroids are placed in the space between the dura (lining of the spinal canal) and the bone. Thought to decrease inflammation in the nerve roots and result in pain relief from "inflamed structures" such as nerves, facet joints or degenerative discs.

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FACET INJECTION

The treatment of facet arthritis by steroid injection. Commonly done but controversial in its effectiveness. A small facet joint is approached with a needle under x-ray control and a small amount of steroid and local anesthetic is placed in the facet.

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FACET JOINT

The small buttressing joints behind the spine. Part of the three-joint complex (two facet joints, disc) that forms the support structure between the intervertebral bones. For more information, please visit our facet joint section in
What's the Spine?

Facet Disease
facet_diseaseIn the image to the left, the cartilage has been eroded and a large spur has extended into the canal. This results in an irregular canal and irritation or compression of the passing nerves. Click on the image for a better understanding.



Enlarge Facet ChangeFacet Change
As vertebrae settle against one another, facets no longer fit well. The empty space which is caused by their shift sometimes fills with fluid, demonstrating the facet spaces.

Facet Osteophytes
Enlarge Facet OsteophytesThe facet joints are true synovial joints about the size of a knuckle. They become malaligned with vertical translation or shifting of the disc during collapse and degenerative change can result in spur formation. The consequence of this degenerative change can be severe causing either local symptoms from arthritic mechanism or a nerve root compression.

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FRACTURE

Compression FractureBroken bone. The most common fractures of the spine are compression fractures where the styrofoam-like bone of the vertebrae is crushed into different shape or pars fractures (spondylolysis) where buttressing posterior elements of the spine crack off the weightbearing vertebral portion.


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FUSION

The method of causing one bone to grow to another. This is a treatment for painful or unstable joints (discs).

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HERNIATED DISC
herniated disc(Also known as a ruptured, slipped, or prolapsed disc.) A disc in which the central supporting structures have ruptured or torn through the outer ligamentous element. This can happen through a number of forms, including loss of interdiscal pressure, whereby the outside ligaments become doubled over or "bulging" or more commonly "ruptured" where the outer annular ligament tears, spilling the nuclear material, which is mucous and protein, into the area around the vertebrae. This usually happens posteriorly into the nerve canal where pressure on the nerve results.


Disc herniation with FragmentHerniated Disc with Fragment
Here is an example of a disc herniation that leaves the fragment in the canal.



Enlarge Traditional Posterolateral HerniationTraditional Posterolateral Herniation
Most often, the disc herniates at its weakest point, which is into the canal. The gray mass coming into the canal would be expected to compress the nerve roots which are passing the disc space at this level and exiting below.


Enlarge Larger Posterolateral HerniationLarger Posterolateral Herniation
In this case, the herniation is larger relative to the size of the canal and importantly, it is placed farther lateral. Compression of the nerve root against the overlying lamina is easy to understand.


Enlarge Central Herniation
Central Herniation
This axial CT image demonstrates the disc herniating posteriorly, more to the left. Such a lesion may cause no symptoms or radicular symptoms depending on the bone anatomy and how the nerve is trapped within the corner between the disc and teh overlying lamina.

Enlarge Foraminal Herniation
Foraminal Herniation
The two examples above demonstrate a more posterior herniation, but the herniation can occur in the foramen as well. The bony anatomy and dimensions here are unforgiving.


Enlarge Foraminal Lateral HerniationForaminal-Lateral Herniation
This axial MRI demonstrates a very large far lateral fragment. Such a fragment would be expected to compress teh exiting nerve root as well as nerve roots traveling along the spine.



For More Information: A Brief Orientation of the Herniated Disc

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INFERIOR ARTICULAR PROCESS

A bony element extending down from the vertebral body on which one-half of the facet joint is mounted. It articulates with the superior articular process of the vertebrae below. The inferior and superior articular processes, pars and pedicles constiture the "posterior elements" that both buttress the vertebral bodies against one another and surround and protect the nerve structures while they are still part of the spine.

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KYPHOSIS

A "humping" of the spine, as if a person has a round back or hunched over appearance.

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LAMINECTOMY

The removal of the lamina. The process by which access to the canal where nerve compression or fragments are waiting.

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LAMINOTOMY

A "window" in the lamina. Smaller than a laminectomy, a laminotomy with magnification can provide excellent access to fragments and compressing elements without risking fracture or unnecessary damage to the pars or facet joints.

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LATERAL RECESS

The corner of the spinal canal where the nerves pass immediate before they leave the spine. The roof of the lateral recess is the facet joint. The floor is the disc. The wall is the pedicle. Nerves are vulnerable in this area because of the confluence of many conforming and encroaching factors (disc, facet capsule, bony elements). A special area of concern in the diagnosis of stenosis. See Stenosis, Lateral Recess.

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LIGAMENT

A general term for connective tissue of specific architecture that connects bone to bone (special conditions elsewhere in the body allow for ligaments to go from skin to bone and so on, but this is generally regarded as "bone to bone").

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LORDOSIS

A straightening of the spine, as if one is looking upward, curved away from the normal rounded spine.

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LUMBAR

The section of the spine below the rib cage and above the pelvis. Typically five mobile segments, the lowest of which are subjective to the majority of forces resulting in mechanical degeneration.|

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MALIGNANCY

Related to cancer.

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MRI

Magnetic Resonance Image. A special computer-enhanced image whereby water molecules are made to glow with radio waves. The computer deciphers the "glow" of water into a picture that very effectively shows soft tissue elements. For more information, visit our MRI section in
Commonly Used Tests and Exams.

Enlarge Normal MRINormal MRI (Sagittal)
This vertical cut is just off the midline through the foramina, where the nerves exit. At each level, one can see that the foraminal openings are quite large and the nerves can exit without difficulty. The disc looks somewhat darker than normal. This is because the cut is off the midline in the drier portion of the annulus.

For More information: Center For Diagnostic Imaging - MR1

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MYELOGRAM

A dye study of the spinal canal. A substance that blocks x-rays dyes the spinal canal. X-ray passing through the spine dyed in this manner will demonstrate shadows or blockages. Still useful but often replaced by the MRI or CT. For more information, visit our Myelogram section in Commonly Used Tests and Exams.

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MYELOPATHY

Damage or injury to the spinal cord.

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NERVE

Nerve CompressionA cable that carries impulses. There are many specific types of nerves, including motor nerves, sensory nerves, and sub groups of nerves (nerves to hot and cold, nerves that carry pain sensations). Individual nerve functions (position sense or sensory functions) can be injured individually as the nerve comes under pressure injury from spinal changes. For more information, please visit our nerve section in What's the Spine?

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PALLIATIVE TREATMENT

The treatment of symptoms. Palliation is a valid scientific method by which symptoms are relieved without addressing the primary disease. Examples include: narcotic prescription, acupuncture or rest.

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PINCHED NERVE

Pinched NerveA nerve that is encroached upon by any number of structures. The nerve may be "pinched" by a disc fragment, by bone spurs, by normal tissue or bones that are pushed together by gravity or other degenerative processes. Nerve irritation and radiculopathies follow typical patterns that can be studied with an anatomic understanding of the problem.

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PROLAPSED DISC

See Herniated Disc.

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PROTRUDING DISC

See Herniated Disc or Bulging Disc.

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Enlarge RetrolisthesisRETROLISTHESIS
Once the interdiscal pressure is lost, vertebrae settle vertically. They may settle backward, (retrolisthesis here) or forward (see spondylolisthesis). The direction depends on the individuals anatomy, posture, or other mechanics.


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ROOT

Nerve Root CompressionA term for a nerve as it exits the spine. Typically numbered by the level at which they leave. The L5 root, the L4 root, etc.







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RUPTURED DISC

See Herniated Disc.

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SI arthrogramSACROILIAC ARTHROGRAM
see image to the right. For an extensive treatment of the sacroiliac joint, please visit our Sacroiliac Joint page.




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SACROILIAC JOINT

SI JointThe joint between the sacrum (an unsegmented, without disc) section of the lower spine and the ilium (the wing or brim of the pelvis). For an extensive treatment of the sacroiliac joint, please visit our Sacroiliac Joint page.

SI joint injectionSI Joint Injection
A method to diagnose problems with the Sacroiliac Joint. For an extensive treatment of the sacroiliac joint, please visit our Sacroiliac Joint page.






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SI fusion pageSACROILIAC FUSION
In this image, the right SI joint has healed, incorporating the bone graft around the metal implant. Compare with the opposite side, this C.T. appearance is ideal and the patient had an excellent result. For an extensive treatment of the sacroiliac joint, please visit our Sacroiliac Joint page.


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SACRUM

An area of unsegmented spine below the lumbar region and above the coccyx. Typically five segments each with their own nerve level relation to the pelvis through the sacroiliac joint. For an extensive treatment of the sacroiliac joint, please visit our Sacroiliac Joint page.

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SCHMORLS NODES
Enlarge Schmorls NodesSerious changes with endplate irregularities are called Schmorl's Nodes. Because of weakness of the endplate or altered mechanics, discs have actually herniated into the vertebral bodies. When this occurs at multiple levels, it is sometimes called juvenile discovenic disease or Scheuermann's.



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SCIATIC NERVE

The nerve that results from the combination of roots in the lumbar spine. After the roots leave the foramina, the rejoin and reorient into a large structure approximately the size of a person's small finger, that provides the motor and sensory functions, and other functions, to the lower extremity.

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SCOLIOSIS
ScoliosisSee diagram







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SLIPPED DISC

See Herniated Disc.

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SPINAL CORD

spinal_cordThe complex element of the central nervous system that extends down from the brain to approximately the first lumbar level. The spinal cord is an extremely delicate structure and different from the nerve roots that typically get pinched in the spine below the LI level. For more information, please visit our spinal cord section in What's the Spine?


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Spinal Cord TumorSPINAL CORD TUMOR
Click on image to enlarge.

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SPINE
You can think of the spine as a series of thick coins or cylinders with one stacked upon another. This stack starts at the pelvis where one specially-designed “coin” is wedge-shaped and lodged into the pelvis. It ends at the skull where the discs take the shape of tiny joints that the skull can sit upon. For more information, please visit our spine section in What's the Spine?


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SPONDYLOLYSIS
This word literally means “lysis” or“dissolution of the spine.” Spondylolysis is a stress fracture, which is a hairline crack of the small hook that latches the vertebra above onto the vertebra below. This hook keeps the vertebra above from sliding forward. For more information, visit Specific Problems of the Spine.

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SPONDYLOLISTHESIS

Spondylolisthesis EnlargeA "slip of the spine". Usually this refers to "lytic" spondylolisthesis or fracture or the pars interarticularis. A listhesis is a "slip" and once the buttressing elements are broken away, the low-grade lytic listhesis occur in a high percentage of the American population (roughly 5%). By themselves, if painless, can often be treated without surgery intervention. In some circumstances the listhesis is severe enough to result in nerve pressure or pain in the disc. In such circumstance surgical options may be considered.

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SPUR

Enlarge SpurA small area of additional bone formed at the edge of the normal bone. It is thought that spurs form in reaction to irritation at the edge of the bone. Spurs by themselves don't usually cause problems, but can in an enclosed area such a as a canal or foramen that compete for space with the nerve, resulting in pressure or the nerve.


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STENOSIS

"Narrowing". Stenosis comes from the same term as stenographer, to make something smaller. Stenosis can apply to any nerve passage, including the central canal (central stenosis). The corners of the canal (lateral recess stenosis) or the foramen (forminal stenosis) where the nerve is pinched in the channel as it leaves the spine. Foraminal stenosis and lateral recess stenosis can be further subdivided as to offending element (posterior structure, anterior structure, facet, disc, etc.).

For More Information:
A Brief Orientation of Spinal Stenosis

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Enlarge Stenosis CentralSTENOSIS, CENTRAL
Encroachment upon a canal from all sides front to back and medial to lateral.



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STENOSIS, FORAMINAL, CIRCUMFERENTIAL

A nerve that receives it encroachment from many different directions.

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FORAMINAL, FRONT/BACK

Encroachment of the nerve root within the foramen by structures approaching it from the anterior (the vertebral body, the disc) or the posterior (facet, spur, facet capsule).

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STENOSIS, FORAMINAL. UP/DOWN

Encroachment of the exiting root by problems coming from above and blow. Usually the pedicle is above and the other elements blow (disc, either ruptured or redundant) or facet.

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STENOSIS, LATERAL

Stenosis of the exiting nerve channel, the foramen.

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STENOSIS, LATERAL RECESS

Stenosis, Lateral RecessOsteophytes form on the facet joint closing down the corner where the normal nerve would exit to escape the spine. In a clothes pin-like fashion, the nerve is squeezed or pinched, causing symptoms at the exiting nerve root.





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VERTEBRA

An individual bone in the spine. There are 7 cervical vertebrae, 12 thoracic vertebrae, and 5 lumbar vertebrae. The vertebrae provide the rigid elements for the supporting spine. The discs that provide the mobile or flexible elements separate them. For a more complete explanation, please visit What's the Spine?

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X-RAY
Plain x-rays are a series of shadows collected on a film. The shadows are not black and white as a shadow in the sun would be, but various stage of gray based on how much x-ray a given tissue will allow to pass. Calcium absorbs most x-ray, and fat absorbs very little. For this reason, and x-ray shows a bone to be quite white and the fat to be black. For more information, please visit our x-ray section in Commonly Used Tests and Exams.

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Copyright 2005 Dr. John G. Stark, All Rights Reserved.