EDUCATION CENTER

Abdominal Aortic Aneurysm

This condition occurs when the abdominal aortic artery - the largest artery running through the abdominal area - becomes enlarged.

Most of the time an abdominal aortic aneurysm is harmless but in rare situations when the aneurysm grows too large and begins either to leak or rupture, it becomes a serious medical emergency requiring surgical intervention.

The most obvious sign that an abdominal aneurysm has torn is persistent pain in the low back and abdominal areas.

Acupuncture

Acupuncture is an integrative medicine technique that has roots in ancient Chinese medicine.

At its core, acupuncture is about keeping energy - called “qi” (pronounced “chi”) in Chinese - flowing freely throughout the body. This is done by inserting paper-thin needles at points on the body called meridians. The theory behind acupuncture is that disease is caused by energy imbalance — so restoring the free flow of “qi” through various meridians may alleviate tension and pain.

Common conditions addressed by acupuncture include neck and back pain and neuropathy, or nerve pain. Traditional medical studies suggest pain is alleviated via chemicals released by the brain -- including endorphins and endogenous opioids -- when the needles are placed.

Other positive side effects of acupuncture include relaxation, increased energy and improved blood flow.

Acute Pain

Acute pain is pain that lasts a relatively short amount of time. This is in contrast to chronic pain, which lasts much longer. Acute pain tends to be severe and come on quickly, with pain relief occurring as the injury heals.

An acute pain episode, caused by things like a broken bone, sprain, or cut tends to last days or weeks - for up to six months. Chronic pain tends to be unremitting, lasting more than six months, and may be fueled by a condition such as fibromyalgia or arthritis.

Allograft Bone

Allograft bone is bone with no living cells that is harvested from either a living donor or a cadaver. It is used in surgical procedures to bridge gaps created by broken bones or bone defects. It is also used to fuse joints, address bone loss and as a healing aid.

A common use for allograft bone is during spine fusion surgery, when it helps to fuse bones in the neck or back that are causing pain into one unified bone. The allograft acts as a temporary bridge that spurs growth in the patient’s own bones so that they eventually replace the allograft. This process is called “creeping substitution.”

Alternative Medicine

Alternative medicine is medical treatment that falls outside the bounds of what is considered traditional or “Western” medicine. Its practitioners emphasize a holistic approach to medicine, including integrating herbs, acupuncture, nutrition, exercise and homeopathy into treatment plans.

Alternative medicine - also called complementary or integrative medicine - generally focuses on non-pharmaceutical, non-traditional approaches to healing. For example, alternative medicine practitioners may prefer chiropractic care for treating back pain rather than standard care.

Increasingly, alternative medicine practitioners are partnering with practitioners of traditional medicine to combine approaches: A chiropractor may work in the same clinic as a spine specialist or the two practitioners might refer patients to one another.

Analgesics

Analgesics are drugs designed to relieve pain without anesthesia (loss of consciousness). There are three main groups of analgesics:

Nonsteroidal anti-inflammatory drugs (NSAIDs) are typically used to address pain and inflammation, which are common back pain symptoms. For this reason, NSAIDs are common and important treatment tools to address various types of back pain. Popular NSAIDs include ibuprofen (brand names, Advil and Motrin), naproxen (Aleve), and prescription Cox-2 inhibitors (Celebrex).

Narcotics, also called opioids, work by binding to pain receptors in the brain and body in order to block the perception of pain. Common narcotics include morphine and methadone. Since narcotics exert very powerful effects on the brain and body, they tend to be much more potent than NSAIDs and acetaminophen - and much more addictive, especially if taken over the long term. Stopping narcotics abruptly may lead to withdrawal symptoms.

Tylenol (acetaminophen) is a non-narcotic pain reliever, but unlike NSAIDs, it does not reduce inflammation. Since it does not react when taken with NSAIDs, the two drug classes are often taken together.

Anesthesiology and Anesthesiologist

Anesthesiology is a branch of medicine that involves determining which drugs best dull the brain’s perception of pain. Anesthesiologists are present both before and after surgery and other medical procedures to administer these drugs. They also closely monitor the patient’s vital signs and the level of anesthetic administered during procedures.

There are three types of anesthesia:

General involves administering medications that lead to loss of consciousness. This is typically used before surgery so that patients “sleep” and therefore do not feel pain during the procedure.

Regional focuses medication to a specific area of the body like an arm or leg to block nerve pain in that area.

Local is applied to a small, specific area of the body, usually by injection. Common sites for local anesthetics include teeth during dental procedures or skin during dermatological procedures.

Anesthesiologists may also participate in fellowships to be certified as pain management or pain medicine specialists. This allows them to directly evaluate, diagnose and treat acute and chronic pain conditions. Treatments given by these specialists include injecting steroidal drugs at pain sites, prescribing pain medication, and performing other procedures. Anesthesiologists may also oversee a patient’s care using other modalities such as psychology and physical therapy.

Ankylosing Spondylitis

Ankylosing Spondylitis is a type of spinal arthritis that results in inflammation of the spine and sacroiliac joints. It can cause spinal joints to get progressively stiffer, leading to impaired movement and chronic pain. As the condition progresses the spine may develop tiny, painful fractures and could eventually result in spinal ligaments and discs fusing together.

As ankylosing spondylitis progresses the body is pulled into an unnatural position, causing the patient to stoop forward. One way to realign the spine involves surgery, although patients undergoing the procedure risk neurological problems.

Inflammation generated by ankylosing spondylitis can spread to other areas of the body including the heart, lungs, kidneys, shoulders and other joints.

Annulus Fibrosus

Intervertebral discs — parts of the spine that provide a cushion between vertebrae — are composed of a fibrous outer shell, called the annulus fibrosus, and a gelatinous inner area, called the nucleus pulposus.

The annulus fibrosus keeps the gel-like nucleus pulposus from leaking and — by keeping the liquid contained — maintains even pressure through the core of intervertebral discs. The annulus fibrosus connects vertebrae both above and below discs, and is considered the spine’s shock absorber.

Anterior Lumbar Interbody Fusion ALIF

Anterior Lumbar Interbody Fusion (ALIF) is a spinal fusion technique in which surgeons enter the front of the body through the abdomen. The procedure involves making an incision on the left side of the abdomen and pulling abdominal contents and muscles to the side to gain access to the front of the spine.

The next step in the procedure involves removing disc material located in the front part of the spine to make room for a bone graft and/or an anterior interbody cage to be inserted.

Unlike spinal fusions that are approached through the back ALIF preserves the nerves and muscles in the back; and it causes compression at the operative site for better bone healing.

But ALIF does have its own unique risks. A major one involves manipulating a major blood vessel to gain access to the spine from the front of the body.

Anterolisthesis

From the front part of each vertebra protrudes a drum-shaped area called the upper vertebral body. Anterolisthesis, also called spondylolisthesis, occurs when the upper vertebral body slips down to the vertebra below it. This slippage has four potential levels of severity ranging from mild (Grade 1, 25% or less slippage) to severe (Grade 4, more than 75% slippage). The level of slippage and nerve involvement greatly affect symptoms.

Anticoagulants

Anticoagulants are drugs that reduce the blood’s ability to coagulate, or clot. Conditions commonly treated with anticoagulants include deep vein thrombosis, atrial fibrillation, pulmonary embolism and stroke.

Patients for whom anticoagulants may be useful include those who are bedridden. Lack of adequate blood flow increases risk for clots developing in leg and pelvic veins. One serious side effect of anticoagulant therapy is excessive bleeding.

Antidepressant

Antidepressant drugs work by balancing levels of certain brain chemicals -- like serotonin, dopamine and norepinephrine -- to improve mood. They are most commonly prescribed to treat symptoms of clinical depression.

There are three main classes of antidepressants:

Monoamine oxidase inhibitors (MAO inhibitors, or MAOIs): Use of MAOIs, the first class of antidepressants to be developed, has declined sharply over the years due to serious side effects and questions about efficacy. Those side effects include weakness, dizziness, sudden dips in blood pressure, anxiety, weight gain and impotence. Some practitioners stand by MAOIs to treat severe conditions like intractable depression and treatment-resistant bipolar disorder.

Tricyclic antidepressants: One of the first classes of antidepressants, tricyclic antidepressants are less commonly prescribed today because of significant side effects -- including blurred vision, constipation, dry mouth, weight gain, and blood pressure problems. Rather than treating mood, some cyclic antidepressants, like amitriptyline and nortriptyline, are used for pain management.

Selective serotonin reuptake inhibitors (SSRIs). The newest class of antidepressants is also the most commonly prescribed for depression. And SSRIs have fewer severe side effects compared with previous drug classes. They work by affecting levels of a mood-controlling brain chemical called serotonin. Maintaining certain levels of serotonin is helpful, for some, with reducing depression. Prozac, Celexa, Lexapro, Paxil and Zoloft are common SSRIs.

Antidepressants are often used off-label, meaning for conditions besides the one for which it was approved. These conditions include anxiety, migraines, sleep disorder, chronic pain, premature ejaculation, and diabetic neuropathy.

Not everyone responds to antidepressants in the same way; and for some patients antidepressant therapy is ineffective. In 2004, the Food and Drug Administration ordered that all antidepressants carry a black-box warning indicating increased risk of suicidal thoughts, feelings and behavior among young people.

Apophyseal Joint

The apophyseal joint, also called the facet joint, is a juncture where two more bones meet in the spine. Apophyseal joints join together like hinges, allowing the spine to flex, extend and twist. They also act as bridges between vertebrae and stabilize the spine.

Each vertebra has an apophyseal joint on the left and on the right. The superior articular facet joint faces up and the inferior articular facet faces down.

Arachnoiditis

Chronic, inflammatory pain in the spinal canal is called arachnoiditis. The condition is marked by inflammation of two areas that house spinal cord nerves: the arachnoid membrane and subarachnoid space. This inflammation may cause the membrane encasing the spine, called the meninges, to stick to the spinal cord and nerve roots.

Symptoms associated with arachnoiditis include numbness, burning, shooting pain, tingling and a sensation similar to skin crawling. More serious cases could result in loss of motor control, bladder and sexual problems, or paralysis.

Bacteria, viruses and chemicals can spur the development of arachnoiditis; so can a direct injury or compression of spinal nerves. Physical therapy and pain management are known to help relieve symptoms of arachnoiditis.

Arthritis

Arthritis is inflammation of the joints, and can manifest as different conditions, including rheumatoid, septic and osteoarthritis.

Osteoarthritis, the most common form of arthritis, results from normal wear-and-tear and aging of joint cartilage. Rheumatoid arthritis is another common form of the condition, and occurs when the immune system attacks joints.

The risk of osteoarthritis -- also called degenerative arthritis -- increases with age. Once cartilage wears away completely, bones that were once cushioned grind against one another, causing bone spurs, bone fusion, limited motion and pain.

Inflammation, or an overactive immune response, is not the sole cause of arthritis. Strains, injuries and repetitive motion may also play a role. Since inflammation is a feature of arthritis, anti-inflammatory drugs like NSAIDs can be effective treatments, as can physical therapy.

Arthrodesis

When vertebrae fuse together either naturally or due to a surgical procedure, the condition is called arthrodesis.

Arthrodesis involves placing a bone graft and/or bone graft substitute during a surgical procedure to immobilize joints.

This procedure is often used to treat spinal pain, motion and stability issues.

Arthropathy

Arthropathy describes any disease of the joints. There is a wide range of arthropathic disorders, including sacroiliitis (inflammation of the sacroiliac joint), Charcot's joints (a condition in which nerve damage degenerates the joint), and arthrogryposis which leads to joint contracture.

Arthroplasty

Arthroplasty involves surgical reconstruction and total replacement of degenerated joints. Arthroplasty requires using prosthetics so design and biomechanics considerations are an integral part of the surgical process.Joint replacements may be composed of materials such as glass, cobalt chromium alloy and Teflon. Common arthroplastic procedures include total hip replacement and total knee prosthesis.

Arthroscopic Discectomy

Arthroscopic discectomy is performed to fix herniated discs in either the cervical or lumbar spine regions. Other decompression procedures, like microdiscectomy, are much more common than arthroscopic discectomy because the latter has a steep learning curve.

Artificial Cervical Disc

When a disc in the cervical spine (neck region) degenerates and causes persistent pain that is not relieved by non-surgical interventions, an artificial cervical disc replacement may be considered.

Artificial cervical discs are technological devices that mimic the function and structure of degenerated cervical discs. Artificial cervical discs are used to restore motion lost in the spine following fusion surgery.

Three artificial cervical discs are currently approved to treat degenerative disc disease: the Prestige® Cervical Disc, the Bryan® Cervical Disc System and the ProDisc™-C.

Artificial Disc Replacement

An artificial disc replacement procedure involves replacing diseased or damaged intervertebral discs with an artificial, man-made device. Artificial discs may be used in either the cervical (neck) or lumbar (lower back) areas of the spine.

Autograft Bone Definition

Autograft bone is bone taken from a patient’s own body to be used for grafting procedures. Bone is taken from one part of the body and transplanted to another part to replace damaged tissues.

Using a patient’s own bone leads to a higher possibility of successful bone fusion. But there are complications related to autografting bones, including fractures, infection, bleeding and tissue damage. Chronic pain at the bone harvesting site is also possible.

For a spinal fusion procedure, autograft bone may be harvested from the hip and placed in between two vertebrae in the spine. This bone bridge creates an environment in which the vertebrae can join together to form one long bone.

Autologous

Autologous blood is a patient’s own blood. Autologous blood transfusion involves drawing a patient’s own blood and reinfusing it back into the body.

Autologous blood carries fewer risks than allogeneic blood (donated by a family member), especially as it relates to acquiring infectious blood diseases like HIV and hepatitis B.

Avascular Necrosis Definition

Avascular necrosis, also referred to as osteonecrosis, is a progressive condition in which bone tissue dies because the blood supply to the region stops either temporarily or permanently. This may lead to bone breaks or complete bone collapse. It tends to affect the femur or joints.

Radiation damage, alcoholism, trauma, and steroid use are common causes for this type of necrosis.

The condition can worsen without treatment and lead to joint or hip pain. Total hip replacement is one treatment option used in severe cases.