Virginia Spine Institute

Conditions & Diagnoses
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Allograft Bone – Sterile bone derived from another human which is used for grafting procedures.

Anterior - The front portion of the body. It is often used to indicate the position of one structure relative to another.

Annulus Fibrosus – The outer, fibrous, ring–like portion of an intervertebral disc.

Apical Vertebra – The most rotated vertebra in a curve; the most deviated vertebra from the patient's vertical axis.

Arthritis – Inflammation of a joint usually characterized by swelling, pain, and restriction of motion.

Arthrodesis – The fusion of bones across a joint space, thereby limiting or eliminating movement. It may occur spontaneously or as a result of a surgical procedure, such as fusion of the spine.

Arthropathy – Any disease or disorder involving a joint.

Arthroplasty – The surgical remodeling of a diseased or damaged joint.

Arthroscope – An instrument inserted into a joint cavity to view the interior of a joint and correct certain abnormalities. An arthroscope is an endoscope for use in a joint.

Arthroscopy – The procedure of visualizing the inside of a joint by means of an arthroscope.

Articular – Pertaining to a joint.

Autogenous Bone – Bone originating from the same individual; i.e. an individual's own bone.

Autograft Bone – Bone transplanted from one part to another part of the body in the same individual.



BMP – Bone morphogenetic protein. A genetically engineered bone substitute (protein) that helps your bone fuse. Used in addition to or instead of your own bone. BMP is not yet FDA-approved for all types of surgery, but surgeons may use the medicine for whatever application they feel is appropriate for the patient. This is called using it “off-label”. We are actively studying this medicine to see how effectively it works. Clearly all data shows that it is very, very safe. Currently BMP is FDA-approved for use in the anterior spine with cages. Use of the product posteriorly is “off-label”.

Bone – The hard tissue that provides structural support to the body. It is primarily composed of hydroxyapatite crystals and collagen. Individual bones may be classed as long, short, or flat.

Bone Graft – Bone, which is harvested from one location in an individual and placed in another individual (allograft bone) or in a different location in the same individual (autogenous bone).

Bone Marrow – The tissue contained within the internal cavities of the bones. A major function of this tissue is to produce red blood cells.



Cervical Spine – Seven spinal segments (C1-C7) between the base of the skull (occiput) and the thoracic spine.

Cancellous Bone – The spongy or honeycomb structure of some bone tissue typically found at the ends of long bones.

Cartilage – The hard, thin layer of white glossy tissue that covers the end of bone at a joint. This tissue allows motion to take place with a minimum amount of friction.

Cervical – The neck region of the spine containing the first seven vertebrae.

Chemonucleolysis – A treatment of an intervertebral disc that consists of an injection of chymopapain, a drug that dissolves part of the disc.

Cobb Angle Measurement – Calculated by selecting the upper and lower end vertebrae in a curve. Erecting perpendiculars to their transverse axes. At their point of intersection, the angle is measured to indicate the curve's angle.

Coccyx - The region of the spine below the sacrum, also known as the tailbone.

Compensatory Curve – A curve, which can be structural, above or below a major curve that tends to maintain normal body alignment.

Compression – The act of pressing together – refers to the loss of vertebral body height either anteriorly, posteriorly or both.

Congenital – Present at and existing from the time of birth.

Coronal – Refers to a section that divides the body into anterior and posterior portions.

Corpectomy – The surgical removal of all or part of the vertebral body.

Cortical Bone – Bone tissue which has been depleted of its minerals; e.g. calcium and phosphorous.



Decompression – This procedure is carried out to relieve pressure on the spinal cord or nerve roots. The pressure may result from fracture fragments, disc fragments, bone spurs, tumors or infections.

Decompression Laminectomy – A posterior approach decompression done by removing the lamina and spinous process.

Disc (Intervertebral) – The tough, elastic structure that is between the bodies of spinal vertebrae. The disc consists of an outer annulus fibrosus enclosing an inner nucleus pulposus.

Disc Degeneration – The loss of the fluid content, structure and functional integrity of the disc.

Discectomy – The excision of the intervertebral disc material that may be described as herniated, implying “bulging” or “ruptured” through the ligaments. If the central fragment of disc material has torn through a hole in the ligament, it is called an extruded fragment or extruded disc. The term herniated nucleus pulposus (HNP) is a catchall phrase for all of these conditions.

Distal – Situated away from or farther from a point of reference; opposite of proximal.



End Vertebra – i. The most cephalad (i.e. toward the head) vertebra of a curve, whose superior surface tilts maximally toward the concavity of the curve. ii. The most caudad (i.e. toward the coccyx) vertebra whose inferior surface tilts maximally toward the concavity of the curve.

Endogenous – Arising within or derived from the body.

Epidural – Situated outside the thin, tough dural membrane that surrounds the brain and spinal cord.



Facet – A posterior structure of a vertebra which articulates with a facet of an adjacent vertebra to form a facet joint that allows motion in the spinal column. Each vertebra has two superior and two inferior facets.

Flatback Syndrome/Fixed Sagittal Imbalance Syndrome – forward posture usually due to a flattened lumbar spine from postoperative or degenerative changes. When viewed from the side, the patient’s head may be several centimeters in front of their hips.

Foramen – An opening allowing for the emerging of spinal nerve roots between two vertebrae.

Foraminotomy – A procedure carried out in conjunction with disc surgery. The foramen (openings for the individual nerve roots to pass from the spine) may become narrowed because of disc impingement, intervertebral collapse, and spondylolisthesis. The surgical widening of the foramen is an attempt to relieve the pressure on the nerve roots.

Fusion – The uniting of two bony segments.



Gardner-Wells tongs – a device used to position the head or apply traction to the neck during surgery. The tongs are attached to your skull with a screw above each ear after you are asleep in surgery.

Gibbus – A sharply angular kyphosis.



Hemivertebra – a congenital abnormality of a vertebral body. Usually a wedge shape which causes scoliosis or kyphosis.

Herniated Disc – Extrusion of part of the nucleus pulposus material through a defect in the annulus fibrosus.

Heterotopic Bone Formation – The occurrence of bone growth in an abnormal location.

Hook – For spinal applications, a metallic medical device used to connect spinal structures to a rod.

Hydroxyapatite (HA) – The lattice–like structure of bone composed of calcium and phosphorous crystals which deposits on collagen to provide the rigid structure of bone.



Idiopathic – unknown cause. No evidence of underlying physical or radiographic pathology. The most common type of scoliosis.

Iliac Bone – A part of the pelvic bone that is above the hip joint and from which autogenous bone grafts are frequently obtained.

Internal Fixation – The immobilization of bone fragments or joints with implants (metal screws, rods, etc.) in order to promote healing or fusion.

Interspinal or intervertebral disc – The structure that normally occupies the space between two moving vertebrae. It is more prominent in the cervical and lumbar spines. It is much like a radial tire. The centermost portion of the disc (nucleus pulposus) is normally composed of a clear gelatinous material that varies in consistency from a firm jelly material to a very thick and less pliable substance. This core is then surrounded by numerous layers of fibrous (fibrocartilaginous) material called the annulus fibrosus. That structure goes to the normal margins of the vertebral body. There is a thick ligament (approximately 2mm) that covers the anterior part of the vertebral body called the anterior longitudinal ligament, and on the spinal canal side posteriorly is the posterior longitudinal ligament.



Joint – The junction or articulation of two or more bones that permits varying degrees of motion between the bones.



Kyphosis – The normal forward curvature of the thoracic spine. The condition “kyphosis” refers to an abnormal increase in this forward curvature.



Lamina – An anatomical portion of a vertebra. For each vertebra, two lamina connect the pedicles to the spinous process as part of the neural arch.

Laminectomy – An operation for removal of part or all of the lamina of a vertebra commonly performed in order to be able to remove an intervertebral disc protrusion or to decompress a nerve root.

Laser – Light Amplified by Stimulated Emission of Radiation. The device that produces a focused beam of light at a defined wavelength that can vaporize tissue. In surgery, lasers can be used to operate on small areas without damaging delicate surrounding tissue.

Lateral – Situated away from the midline of the body.

Lordosis – The normal mild “swayback” curve of the lumbar spine.

Lumbar spine – Five mobile segments of the lower back (L1 to L5). These are the largest of the vertebral segments and provide most of the bending and turning ability of the back, in addition to bearing most of the weight of the body.



Medial – Situated closer to the midline of the body.

Minimally Invasive Surgery – Surgery requiring small incision(s), usually performed with endoscopic visualization.



Nerve Root – The portion of a spinal nerve in close proximity to its origin from the spinal cord.

Non–Union – Failure of the fragments of a fractured bone to heal or to obtain bony fusion following an arthrodesis.

Nucleus Pulposus – The semi–gelatinous tissue in the center of an intervertebral disc. It is surrounded and contained by the annulus fibrosus which prevents this material from protruding outside the disc space.



Orthopaedics (also Orthopedics) – The medical specialty involved in the preservation and restoration of function of the musculoskeletal system that includes treatment of spinal disorders and peripheral nerve lesions.

Ossification – The process of forming bone in the body.

Osteoporosis – A disorder in which bone is abnormally brittle, less dense, and is the result of a number of different diseases and abnormalities.

Osteotomy – the surgical removal of a wedge or piece of vertebral bone to alter the alignment of the spine.



Pelvic Obliquity – Deviation of the pelvis from the horizontal in the frontal plane. Fixed pelvic obliquities can be attributed to contractures either above or below the pelvis.

Periosteum – A fibrous membrane that covers the surface of bone except at the end of the bones where it is covered with cartilage as part of a joint. In children, periosteum is involved in forming new bone and molding the configuration of bone; and in the adult, the periosteum forms new bone secondary to injury or infection.

Physical Therapy – The treatment consisting of exercising specific parts of the body such as the legs, arms, hands or neck, in an effort to strengthen, regain range of motion, relearn movement and/or rehabilitate the musculoskeletal system to improve function.

Posterior – Located behind a structure, such as relating to the back side of the body.

Proximal – Nearer or closer to a point of reference; opposite of distal.

Pseudarthrosis – an area of the spinal fusion where the bone did not heal (fuse). Often found with broken instrumentation and, in some instances increased pain, although not always.





Resection – The surgical removal of part of a structure, such as bone.

Resorption – The removal of bone tissue by normal physiological process or as part of a pathological process such as an infection.

Rhizotomy – Surgical transection of a nerve root.

Rib Hump – The prominence of the ribs on the convexity of a spinal curvature, usually due to vertebral rotation best exhibited on forward bending.

Rod – In spinal applications, a slender, metal implant which is used to immobilize and align the spine.

Rotation – The movement of one vertebra to another about its normal or abnormal coronal axis.



Sacral spine – (sacrum) - The five fused segments of the lower spine that connect to the pelvis and have four foramen on each side.

Sagittal – Refers to a lengthwise cut that divides the body into right and left portions.

Sciatica – A lay term indicating pain along the course of a sciatic nerve, especially noted in the back of the thigh and below the knee.

Scoliosis – Lateral (sideways) curvature of the spine. Rotation of the vertebrae also occurs which produces the rib cage asymmetry.

Spinal Canal – The long canal between the vertebral bodies anteriorly and the lamina and spinous processes posteriorly through which the spinal cord passes. The spinal cord and nerve roots extend to the level of the second lumbar segment in adults. Below this level are numerous nerve roots from the spinal cord that resemble a horse’s tail and is referred to as such (cauda equina). The thick outer covering of the spinal cord is called the dura.

Spinal Cord – The longitudinal cord of nerve tissue that is enclosed in the spinal canal. It serves not only as a pathway for nervous impulses to and from the brain, but as a center for carrying out and coordinating many reflex actions independently of the brain.

Spinal Fusion – A surgical procedure to permanently join bone by interconnecting two or more vertebrae in order to prevent motion.

Spinal Stenosis – Reduction in the diameter of the spinal canal due to arthritic overgrowth of bone and soft tissue, which may result in pressure on the spinal cord or nerve roots.

Spinous Process – The portion of the vertebrae that protrudes posteriorly from the spinal column. The spinous processes create the “bumps” felt on the midline of the back.

Spondylolisthesis – A defect in the construct of bone between the superior and inferior facets with varying degrees of displacement so the vertebra with the defect and the spine above that vertebra are displaced forward in relationship to the vertebrae below. It is usually due to a developmental defect or the result of a fracture.

Spondylolysis – (also referred to as a stress fracture or a pars fracture) - Fracture of a posterior portion of the vertebra. A defect in the neural arch between the superior and inferior facets of vertebrae without separation at the defect and therefore no displacement of the vertebrae. It may be unilateral or bilateral and is usually due to a developmental defect but may be secondary to a fracture.

Stainless Steel – Iron–based metal containing chromium that is highly resistant to stain, rust, and corrosion. Certain grades of stainless steel are commonly used to make surgical implants and instruments.

Sterile – Free from living organisms.

Sterilization – The method used to render a material free from living organisms. Usual methods include steam under pressure, gas, and ionizing radiation.



Thoracic spine - Twelve spinal segments (T1-T12) incorporating the 12 ribs of the thorax. Other than a slight increase in size from top to bottom, they are fairly uniform in appearance.

Titanium – A metallic element used to make surgical implants.

TLIF – Transforaminal Lumbar Interbody Fusion – a way to do an anterior fusion (front of the spine) from a posterior approach.

Transition Syndrome – a degenerative change with bony instability above or below a previous fusion.





Vertebra – One of the 33 bones of the spinal column. A cervical, thoracic, or lumbar vertebra has a cylindrically shaped body anteriorly and a neural arch posteriorly (composed primarily of the laminae and pedicles as well as the other structures in the posterior aspect of the vertebra) that protect the spinal cord. The plural of vertebra is vertebrae.

Vertebral End–Plates – The superior and inferior plates of cortical bone of the vertebral body adjacent to the intervertebral disc.



Wire – Metal thread available in various diameters and various degrees of stiffness and is generally used in surgery to transfix fractured bone.