LBP Guidelines: Interventional, Surgical, Interdisciplinary
Glossary
Artificial disc
replacement
Replacement of a degenerated disc with a prosthetic disc, in order to remove the
presumed source of pain while theoretically preserving normal range of motion
and mechanics of the spine.
Botulinum toxin
injection
Injection of botulinum toxin (an antispasmodic) into the muscles of the back.
Chemonucleolysis
Treatment of herniated discs with intradiscal injections of a proteolytic enzyme,
most commonly chymopapain (an extract from papaya). Chymopapain acts by
digesting the jelly-like inner portion of the disc known as the nucleus pulposus,
while at the same time, leaving the outer portion, the annulus fibrosis, essentially
intact.
Chronic low back
pain
Low back pain present for more than 3 months.
Coblation®
nucleoplasty
A procedure involving the use of a bipolar radiofrequency current in order to
create a series of channels in an intervertebral disc and reduce the volume of
tissue.
Degenerative
spondylolisthesis
A condition characterized by degenerative changes at the facet joints, which
leads to a loss of normal structural supports and forward subluxation of the
affected vertebral body on the vertebral body below (spondylolisthesis).
Degenerative spondylolisthesis is a common cause of spinal stenosis.
Diagnostic facet
joint block
The injection of local anesthetic into the facet (zygapophyseal) joint using
fluoroscopic guidance. Resolution of back pain is thought to indicate that the
facet joint is the source of symptoms.
Diagnostic
sacroiliac joint
block
The injection of local anesthetic into or around the sacroiliac joint. Resolution of
back pain is thought to indicate that the sacroiliac joint is the source of
symptoms.
Diagnostic
selective nerve
root block
The injection of local anesthetic around a spinal nerve root using fluoroscopic
guidance. Resolution of radiculopathy is thought to indicate that the particular
nerve root is the source of symptoms.
Disabling low back
pain
Low back pain that causes restriction of normal activity or function.
Discectomy
Removal of part or all of an intervertebral disc, usually to relieve pressure from a
herniated disc on a nerve root. Standard open discectomy involves removal of
the disc via standard surgical incision and surgery performed with direct
visualization, often with laminectomy. Microdiscectomy involves a small incision
in the back and use of an operating microscope to perform the surgery.
Discogenic low
back pain
Back pain thought to be caused by a painful intervertebral disc, typically as a
result of degenerative disc disease.
Epidural steroid
injection
Injection of corticosteroids via a catheter into the space between the dura and the
spine. Common approaches for administering epidural steroid injections are
through the interlaminar space, via the neuroforamen under fluoroscopic
guidance (transforaminal), and through the sacral hiatus at the sacral canal
(caudal).
Facet joint pain
Back pain thought to be caused by a painful facet (zygapophyseal) joint, typically
as a result of degenerative or arthritic changes.
Facet joint steroid
injection
Injection of corticosteroid into the facet joints.
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LBP Guidelines: Interventional, Surgical, Interdisciplinary
Glossary
Fusion surgery
A surgical procedure that unites (fuses) two or more vertebrae together, in order
to restrict spinal motion at that site and relieve pain.
Interdisciplinary
rehabilitation
An intervention that combines and coordinates physical, vocational, and
behavioral components and is provided by multiple health care professionals with
different clinical backgrounds. The intensity and content of interdisciplinary
therapy varies widely.
Interspinous
spacer device
A surgical procedure that involves placement of a spacer device between the
interspinous processes, in order to improve symptoms of spinal stenosis by
reducing or limiting extension or lordosis of the spine.
Intradiscal
electrothermal
therapy (IDET)
A procedure involving the placement of an electrode or catheter into the
intervertebral disc annulus or nucleus and applying electrothermal energy to alter
adjacent pain receptors or other structures.
Intradiscal steroid
injection
Injection of corticosteroid into the intervertebral disc.
Laminectomy
Removal of the vertebral lamina in order to create more space and reduce
pressure on the spinal column or nerve roots. Can be performed with or without
fusion or discectomy.
Local injections
Injection of local anesthetic (with or without corticosteroid) into the muscles or
soft tissues of the back. Trigger point injections, a type of local injection, involve
an injection performed at a tender area, often with a palpable nodule or band.
Medial branch
block
Injection of local anesthetic with or without corticosteroid in the area of the medial
branch of the posterior primary ramus, the primary nerve innervating the
intervertebral facet joint. Usually used as a diagnostic procedure to identify facet
joint pain, but has also been used as a therapeutic procedure.
Non-radicular low
back pain
Back pain without leg pain or other symptoms suggesting radiculopathy or spinal
stenosis.
Nonspecific low
back pain
Pain occurring primarily in the back with no signs of a serious underlying
condition (such as cancer, infection, or cauda equina syndrome), spinal stenosis
or radiculopathy, or another specific spinal cause (such as vertebral compression
fracture or ankylosing spondylitis). Degenerative changes on lumbar imaging are
usually considered nonspecific as they correlate poorly with symptoms.
Percutaneous
intradiscal
radiofrequency
thermocoagulation
(PIRFT)
A procedure involving the placement of an electrode of catheter into the
intervertebral disc and applying alternating radiofrequency current. Sometimes
classified as a variant of intradiscal electrothermal therapy (IDET).
Persistent low
back pain
Low back pain that does not resolve despite use of one or more recommended
interventions.
Prolapsed (or
herniated) disc
Herniation of the nucleus pulposus of an intervertebral disc through its fibrous
outer covering, which can result in compression of adjacent nerve roots or other
structures and may cause radiculopathy.
Prolotherapy
A procedure involving the repeated injection of an irritant chemical into the soft
tissues of the back in order to provoke an inflammatory response that will
theoretically subsequently lead to strengthening of the soft tissues with decrease
in pain and disability. Also referred to as sclerotherapy.
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LBP Guidelines: Interventional, Surgical, Interdisciplinary
Glossary
Provocative
discography
The injection of radiographic contrast material into the nucleus of an
intervertebral disc. Reproduction of a patient’s typical back pain is thought to
indicate the disc as the source of back pain (“discogenic low back pain”).
Radiculopathy
Dysfunction of a nerve root associated with pain, sensory impairment, weakness,
or diminished deep tendon reflexes in a nerve root distribution.
Radiofrequency
denervation
A procedure involving the destruction of nerves using heat generated by a
radiofrequency current.
Sacroiliac joint
pain
Back pain thought to be caused by a painful sacroiliac joint, typically as a result
of degenerative or arthritic changes.
Sacroiliac joint
steroid injection
Injection of corticosteroid into or around the sacroiliac joint.
Sciatica
Pain radiating down the leg below the knee in the distribution of the sciatic nerve,
suggesting nerve root compromise due to mechanical pressure or inflammation.
Sciatica is the most common symptom of lumbar radiculopathy.
Spinal cord
stimulation
A procedure involving the placement of electrodes in the epidural space adjacent
to the area of the spine presumed to be the source of pain and applying an
electric current in order to achieve sympatholytic and other neuromodulatory
effects.
Spinal stenosis
Narrowing of the spinal canal that may result in bony constriction of the cauda
equina and the emerging nerve roots, which can cause neurogenic claudication,
or symptoms of leg pain (and occasionally weakness) on walking or standing,
relieved by sitting or spinal flexion.
Subacute low back
pain
Low back pain present more than 4 weeks but less than 3 months.
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