Глоссарий
Annulus fibrosus
Fibrous ring which surrounds the intervertebral disc.
Arthroscopy (endoscopy of joints)
During an arthroscopy, an endoscope with a camera is inserted into the joint, which is to be treated or examined, by means of a small incision. Possible damage can be diagnosed and treated using this probe.
Catheter
A catheter is a thin, tubular instrument. It can be equipped with different attachments such as cameras or heat probes. Open surgery can often be avoided by using a catheter.
Chronic
The term “chronic“ is used for medical conditions which usually develop slowly and last for a long period of time.
Computer tomography (CT)
During a computer tomography, specific tomographic images of the body are generated at various levels using X-rays and calculated with the computer.
Conservative measures
Conservative measures are types of treatment, which do not require a surgical procedure. This includes physiotherapy, physical therapy, pain relieving injections or orthopaedic-technical aid such as surgical corsets for example.
Conventional diagnostic radiology
X-rays of the spine are usually made at at least two levels. Functional images show the spine curved and stretched and enable estimating the mobility. Images from a diagonal beam projection provide information about a possibly existing abnormal mobility of the vertebral bodies. However, only the bony structures with possibly degenerative modifications can be detected with conventional diagnostic radiology.
Discography
During a discography, a contrast medium is injected into the intervertebral disc and then an X-ray is created. This way, existing damage can be made visible.
Endoscopy of the joints (arthroscopy)
During an endoscopy, an endoscope with a camera is inserted into the joint, which is to be treated, by means of a small incision. Possible damage can be diagnosed and treated with special devices using this probe.
Epidural irrigation
During an epiduroscopy, an irrigation of the spinal canal, a so-called epidural irrigation, can be conducted using a catheter. In doing so, the inflamed tissue can be treated with medication.
Epiduroscopy
An epiduroscopy is an endoscopy of the spinal canal. In the process, a small camera on the tip of a catheter allows for a direct view of the damage in this area. Furthermore, irrigations can be con-ducted through the catheter and inflamed tissue can be treated with medication.
Facet joint blocks
Modifications in the small vertebral joints can often lead to pressure sensitivity respectively pain when moving. This pain is specifically deactivated during the facet joint block to ensure that the stiffening/fixation of the joint is truly the cause of the pain. To do so, pain inhibiting and anti-inflammatory substances are brought precisely to the affected joint via a probe and under CT guidance.
Facet joint osteoarthritis
The modification of spinal statics leads to an increased strain on the facet joints, which develop bony extensions and which can also compress the nerve roots through the increase in volume. A swelling of the vertebral arches is the result. That leads to a narrowing of the spinal canal with neurological symptoms.
Facet joint treatment
Local, belt-like or pseudoradicular pain goes along with degenerative modifications in the area of facet joints with accompanying inflammatory modifications. In this procedure a cortisone preparation and a pain reliever is injected directly into the aching joint under CT guidance.
Foramen intervertebralis
There is an opening on the side between the vertebral arches. It is the intervertebral foramen. The spinal nerves come out of the spinal column through this opening. The spinal nerves, which come out of the spinal column are divided into four branches. The ramus meningeus sensitively provides for the meninx, the spinal canal as well as the front portions of the articular capsule of the facet joints.
Herniated disc (prolapse)
A prolapsed intervertebral disc is defined as a sudden or slowly increasing posterior shift of intervertebral tissue into the spinal canal or towards the back from the side in the direction of the nerve root opening. The pressure, which this causes on the nerve roots, can lead to pain, paralysis and/or sensation disorders.
Image converter
This is a mobile X-ray apparatus for X-ray examinations. Medical instruments can be precisely controlled and operated using this procedure.
Injection
The placement of medication e.g. into the body by means of a hypodermic needle (hollow needle) is called an injection.
Intervertebral disc cell culture
During this novel procedure, intervertebral tissue is extracted from the patient using highly fine, special instruments, in order to then cultivate these in a cell laboratory, which is specifically intended for this purpose. The growing intervertebral tissue is then transplanted directly into the affected intervertebral disc.
Kyphosis
Kyphosis is typically, merely a minorly distinctive posterior curvature of the thoracic spine. The term kyphos is of Greek origin and means "hunched", "stooped".
Laminectomy
During this procedure one or several vertebral arches including the dorsal processes in the region of the lumbar spine are removed. It is conducted for the relief of the spinal nerves in the spinal canal in cases of an existing lumbar spinal stenosis.
Laser disc ablation
This procedure is based on the principle of reducing the volume of the disc. A medical laser serves the ablation of the disc, which emits light in at an infrared range. This light is conducted to the surgical field via a glass fibre. To be able to do this, a cannula is inserted into the affected region of the intervertebral disc and the position of the cannula tip is guided by means of radiography or CT. This cannula is double-walled and a rinsing fluid is passed through it for cooling. The glass fibre of the laser is inserted through the cannula and the nucleus is evaporated through single flashes.
Lordosis
Lordosis, derived from the Greek word lordos = curved inward, is used to describe an inward curvature of the cervical and lumbar spine.
Lumbago
Lumbago describes suddenly arising back pain – commonly known as low-back pain.
Lumbalgy
Lumbalgy describes chronic back pain.
Lumbar spinal stenosis
This disorder defines the narrowing of the spinal canal, which is usually age-related, e.g. due to a herniated disc. In the process, the functionality of the nerves, which run through the spinal canal, is impaired. The result is diffuse back pain, which can radiate into the legs and, as the case may be, cause numbness in the buttocks and legs. The symptoms are typically intensified in a stretched position and reduced in a stooped position. Persons with this disorder often walk with a hunched back.
Lumboischialgia
Lumboischialgia refers to low-back pain which also radiates into the legs.
Magnetic resonance imaging
Magnetic resonance imaging provides sectional images of the body without a surgical procedure or radiographic exposure. To do so, a magnetic field is established. It supplies information about the water content of the examined tissue. This enables portraying the degree of stiffening/fixation of the intervertebral disc for example or of the cartilaginous coating.
Minimally invasive procedures
Open surgeries are generally associated with risks and a longer hospital stay. Minimally invasive procedures were developed to avoid open surgery with its possible disadvantages and risks and to keep the procedure as small as possible. For example, a catheter or probe can be applied, which is inserted directly into the visceral cavity by means of a small incision or puncture and which allows for direct treatment there. This usually spares the patients any scarring. They can normally be conducted as outpatient procedures or merely require brief hospitalisation. They are performed under local anaesthesia and usually do not require general anaesthesia. In particular, radiologic methods serve the control and inspection of the therapeutic measures and findings.
MRT
MagnetResonanceTomography, NMR (nuclear magnetic resonance), magnetic resonance imaging
Magnetic resonance imaging, also called magnetic resonance tomography (MRT), is a diagnostic technique to provide an image of internal organs, tissue and joints with the help of magnetic fields.
Myelography
A myelography can be conducted to display the spinal cord and nerve roots. During this procedure, a radiological contrast medium is filled into the dural sac with a cannula. In doing so, the spinal cord and nerve roots, which lie within, are portrayed indirectly in the X-ray as contrast medium recesses. However, contrary to sectional imaging procedures, this is only used rarely today.
Neurological examination
A comprehensive neurological examination is important for the specific treatment of back pain because it provides information about the affected pain-causing nerves. Particularly in the case of herniated discs, this can determine the severity of the nerve damage and therefore, the indication for a possible surgical procedure can be given. To do so, the reflexes, sensibility, mobility and possibly the nerve transmission speed are determined. Conclusions can be drawn from the radiation of the pain to the involved nerve roots. The examination of the pulse in the legs is intended to rule out circulatory disorders in this area. Intermittent claudication (leg angina) can cause pain, which at a first glance can be similar to degenerative spinal disorders.
Nucleus pulposus
Gel-like core, central part of the intervertebral discs, which contains the chondrocytes.
Osteoarthritis
The degradation of the joints is called osteoarthritis. The joint partners of joints are covered with a protective layer of cartilage. This protective layer can be affected by injuries, inflammations or stiffening/fixation or become partially or completely depleted.
Osteomyelitis
In the case of endogenous osteomyelitis, also called haematogenous osteomyelitis, the germs from the source of an infection outside the bone, e.g. from the maxillary sinuses, are carried into the bone marrow through the bloodstream and colonise there. Exogenic osteomyelitis develops as a result of injuries (= posttraumatic) or operations (= postsurgical). Here, viruses penetrate the bones from the outside and spread there. Regions with reduced blood flow are particularly at risk. Acute and chronic progression must also be differentiated here.
Osteoporosis
Osteoporosis is the reduction of bone mass, structure and function, so-called decalcification, which leads to a painful, mechanical instability of the skeleton with the risk of bone fractures. During this process, calcium is continuously withdrawn from the bones. The most important types of osteoporosis are postmenopausal and osteoporosis in old age. In general, osteoporosis is based on an unbalance between bone formation and resorption.
Percutaneous nucleotomy
This procedure is particularly suitable for patients with back pain involving the legs and symptoms, which can be attributed to a root. For this purpose, a cannula is inserted under CT guidance and pushed forward through the annulus fibrosus into the intervertebral disc space. Then the nucleus pulposus is partially extracted with a suction device. In this manner, a total of 1-5g of intervertebral disc material is removed.
Peridural pain therapy
Often, back pain cannot be clearly associated with a nerve root. In these cases, peridural therapy can be suitable. The physician inserts a thin cannula into the fat filled space which encloses the dural sac in the spinal canal under X-ray or CT guidance and places a depot of medication consisting of cortisone as a depot preparation and a pain reliever there.
Periradicular pain therapy
This procedure is applied for the treatment of pain, which can be attributed to a specific nerve root. In doing so, a thin cannula is brought very close to the affected nerve root by an experienced physician and under the guidance of X-ray radioscopic equipment or CT. A pain reliever and cortisone as a depot preparation are then directly injected into the nerve root. This provokes a detumescence of the nerve root and an inhibition of inflammation.
Prophylaxis
There are no specific precautions, which can protect against getting a herniated disc. Nevertheless, the risk can be reduced through a change in lifestyle. This includes the strengthening of the back muscles through exercise. Furthermore, proper posture while working is necessary, in particular for household work and on the job. Heavy objects should only be lifted in a squatted position with a straightened back. When vacuuming, the suction pipe should be adjusted in a manner which allows maintaining an upright, relaxed working posture. For work, which is mainly carried out sitting, it is reasonable to get up every now and then and to walk around a bit. There are also programmes with relaxation exercises especially for these occupation groups. An ergonomic layout of the seating with height adjustable seats and backrests can contribute to protecting the spine.
Protruding disc (protrusion)
A protruding disc is the preliminary stage of a herniated disc. Due to a step-by-step degradation of the annulus fibrosus, this fibrous ring gives way to the pressure of the nucleus pulposus and protrudes beyond the contour of the vertebral body. During this process however, the fibrous ring itself remains intact. A protruding disc is sometimes enough to cause neurological deficiencies.
Pseudoradicular pain
Modifications in the area of the small vertebral joints are the cause for pseudoradicular pain. In cases of radicular pain, nerve roots are irritated for example through compression by a prolapsed disc.
Racz catheter
Pain catheter treatment according to Prof. Racz serves the treatment of painful modifications in the region of the spinal canal. In the process, a special catheter is inserted into the spinal canal through a natural bone opening in the tailbone (coccyx). The physician positions it precisely in the inflamed and narrowed spot of the nerve under X-ray guidance. Various anti-inflammatory, analgesic and scar removing substances are brought directly to the location of the pain. Furthermore, the surrounding tissue is dehydrated and shrunk with a concentrated saline solution so that it can no longer compress the nerves.
Radicular pain
Radicular pain occurs when a nerve root is irritated e.g. through compression due to a herniated vertebral disc. Modifications in the region of the small vertebral joints are the cause of pseudoradicular pain.
Recurrent
Recurrent pain is periodical discomfort, which recurs at certain intervals.
Scheuermann’s disease
Scheuermann’s disease is a curvature of the spine which primarily occurs in male adolescents and which is caused by a skeletal disorder of the vertebral bodies and the formation of wedge-shaped vertebrae. The development of an intensified form of kyphosis, i.e. a humpback, in the region of the thoracic spine is typical for this disease. On the other hand, a flattening of the lordosis in the lumbar region occurs much more rarely.
Sciatic pain
Pain, which radiates into the legs, is called sciatic pain.
Sectional imaging procedures
The spinal cord and the nerve roots only become directly visible using sectional imaging procedures, computed tomography and magnetic resonance imaging. An additional intravenous administration of a contrast medium simplifies the classification of inflammatory processes in these two procedures.
Spinal canal
Every vertebral body has a posterior vertebral arch. In their totality, they form the spinal canal through which the spinal cord runs. Both the transverse processes and the dorsal process, which can be felt through the skin, are the points of attachment for the back muscles. The dorsal processes are bent downward and lay imbricated over one another. Each vertebral arch also has four articular processes, which form a joint (facet joint) with the above and underlying joint, which enables the mobility of the joints against each other but also limits it in certain directions.
Spinal column
The spinal column (medically: columna vertebralis) defines the body’s flexible axial skeleton. The spinal column consists of the vertebrae, the intervertebral discs and the corresponding ligaments whose job it is to connect and stabilise the spinal structures. The human spine primarily consists of a total of 32-33 vertebrae and is made up of 7 cervical vertebrae, the so-called cervical spine, 12 thoracic vertebrae, the so-called thoracic spine and 5 lumbar vertebrae, the so-called lumbar spine as well as 5 sacral and coccygeal vertebrae. The latter vertebrae fuse into the sacral bone and tailbone between the ages of 20 to 25.
The intervertebral discs are situated between the vertebrae, whose main task is to absorb intense movements. Together with the vertebral bodies, the vertebral bodies and the intervertebral discs form an elastic „column“. Each vertebra consists of a vertebral body (corpus), the vertebral arch (= arcus), which joins the vertebral body and the so-called processes, which convey the strength of the musculature to the vertebrae but also to the articular processes. The spinal canal contains the spinal cord.
Thermocoagulation of the vertebral joints (facet joints)
This treatment is also called thermo-probe treatment. If a degenerative modification of a vertebral joint is determined as the cause of back pain, a heat probe treatment of the vertebral joints can be conducted. A thermo-probe is brought into the region of the painful nerve fibres under CT guidance. Then the nerve is briefly stimulated for checking purposes before local anaesthesia is administered and the tip of the probe is heated. This way a small area is cauterised so that the transmission of the pain fibres is disrupted.
Vertebral joint blocks
Modifications in the small vertebral joints can often lead to pressure sensitivity respectively pain when moving. This pain is specifically deactivated during the vertebral joint block to ensure that the stiffening/fixation of the joint is truly the cause of the pain. To do so, pain inhibiting and anti-inflammatory substances are brought precisely to the affected joint via a probe and under CT guidance.
