CONDITIONS/DIAGNOSES

Spondylosis- Generic term used to describe osteoarthritis of the spine. Typically this
may include bone spurs, loss of disc height or any other wear and tear type
changes.
Degenerative Disc Disease (DDD)- is synonymous with Spondylosis. DDD is the
term/diagnosis given for loss of disc height/consistency. This is most evident on MRI
seen as not only loss of height, but also desiccation (loss of water content
represented as darkening or loss of white color).
Spondylolisthesis- is when there is a misalignment of one vertebral body in
comparison to the one above or below. Most commonly this is seen when the bone
is shifted forward (anterolisthesis), and occasionally when it shifts backwards into
the canal space (retrolisthesis). But generally we just call it Spondylolisthesis.
Sometimes it is caused by a fracture in which case we call it an isthmic
Spondylolisthesis (see spondylolysis).
Stenosis- is the narrowing/pinching of a tube like area (ex: spinal stenosis, aortic
stenosis, etc.). In spine we are obviously referring to spinal stenosis. This can be
further defined as central canal stenosis, foraminal stenosis (narrowing in the
vertebral foramen), and less commonly lateral recess stenosis.
Scoliosis- is any curvature in the spine. In order to be technically classified as
scoliosis, the curvature must me greater than 11 degrees. We often see children
(JIS- Juvenile Idiopathic Scoliosis) and adolescents (AIS- Adolescent Idiopathic
Scoliosis) with this condition. Adults can also have scoliosis, typically though, it is in
the lumbar spine and due to moderate-severe arthritis (Spondylosis), and we call
this degenerative lumbar scoliosis.
Compression Fracture- is seen on imaging studies and involves the anterior 2/3 rd of
the vertebral body. It will appear as an obvious compression and is typically given
a % compressed.
Burst Fracture- is a less common type of vertebral body fracture where the posterior
1/3rd of the vertebral body will be compressed.
Spondylolysis- is a fracture of the pars interarticularis. This facture is also known as
pars fracture or stress fracture. In some cases, the fracture itself will allow enough
instability to cause the vertebral body to shift called isthmic Spondylolisthesis.
Coccydynia- is the medical term/diagnosis for tail-bone pain.
Herniated Nucleus Pulposus (HNP)- is when part of the intervertebral disc bulges out
and can cause nerve irritation or stenosis. The disc itself consists of 2 main layers;
the outside (annulus fibrosis) which is a tougher more fibrous protection layer and
the inside, nucleus pulposus which has a slightly less dense consistency.

Radiculopathy- is the physical and mechanical pinching of a nerve (at the nerve
root) that travels to an extremity causing pain or other symptoms, often referred to
as radicular symptoms or just radiculopathy (**Can only be confirmed on MRI/CT
myelogram-many PCPs will use this as an assessment before pt is even seen by a
spine specialist**).
Radiculitis- is sometimes used to describe upper or lower extremity pain when there
is no clear evidence of nerve root pinching on imaging.
Strain- most commonly the cause of neck or back pain associated with a specific
event/accident. If muscle/soft tissue inflammation is the only underlying problem,
the exam will typically be normal with the exception of tenderness on palpation and
potentially some decreased ROM.

COMMON TESTS
X-ray- typically always required for new patients unless they are bringing in a CD or
film from outside imaging center.
MRI- allows for better visualization of the spinal cord/nerves as well as soft tissue.
Usually when a patient has a compression fracture as seen on X-ray, an MRI will be
ordered with a special sequence called STIR ( i.e. Lumbar MRI with STIR images);
this sequence will help determine the relative state/acuity of the compression
fracture (new/old).
CT- allows for better visualization of bone structures. **CT myelogram can be
ordered when an MRI is not feasible in the case of cardiac pacemaker or other
common contraindications.
BONE SCAN- nuclear imaging test that evaluates for hypermetabolic areas which
will show up as either darker or lighter areas depending on sequence. Can be useful
in assessing for fracture acuity and or other bony pathology such as a primary
cancer with mets to bone (often vertebrae are involved).
DEXA- (dual energy xray absorptiometry) used to look at bone density, i.e.
evaluating for osteopenia/porosis.
EMG/NCS- electromyography/nerve conduction study is a test done by a pain
management/neurology specialist to evaluate the relative condition of nerves in the
extremities. EMG/NCS is sometimes useful in distinguishing between neck/back
pathology vs. other extremity or neurogenic condition. For example: a patient with
upper extremity pain and parasthesias in the hand may be caused by something
like carpal tunnel or even cubital tunnel syndrome. (EMG in combination with MRI

will help determine if the problem is caused by arthritis in the neck or carpal tunnel
syndrome).

COMMON NON-SURGICAL TREATMENT

Physical Therapy- useful for many different conditions to help build up muscle.
Doing so will allow more of the stress to pass through soft tissue vs. the spine.
NSAIDs- generally Aleve is recommended as the best option in the class of OTC
medication.
Medrol Dose Pak- A week long pack of steroid (Methylprednisolone) to help reduce
the amount of inflammation and nerve irritation.
Activity Modification- temporarily avoiding activity that aggravates symptoms.
Steroid Injection- an injection of steroid concoction delivered under x-ray guidance
by a pain management specialist. Several different types of injections are available,
i.e. epidural (midline/transforaminal), coccyx, bura, trigger point.
Pain Medication- OTC or prescription analgesics.

COMMON SURGICAL TREATMENT

Hemilaminotomy/Microdiscectomy- typical surgery to treat a symptomatic herniated
disc.
Laminectomy- typical surgery to treat symptomatic central canal stenosis.
Anterior Lumbar Interbody Fusion (ALIF) - anterior surgical approach typically for
severe L4-S1 DDD or symptomatic Spondylolisthesis.
Extreme Lateral Interbody Fusion (XLIF) - lateral surgical approach for lumbar DDD.
Typically more useful for upper lumbar levels because a lateral approach for lower
lumbar levels would be blocked by the iliac crest.
Instrumented Posterior Spinal Fusion (instr PSF)- posterior surgical approach to fuse
two or more levels with using instrumentation (screws and rods).