Glossary

Arthroscope

An arthroscope is a surgical instrument that consists of a tiny tube, a lens and a light source. It is used in arthroscopic surgery which is a method of viewing a joint and repairing any problems with minimal trauma to the body. During the arthroscopic surgical procedure, the arthroscope is inserted into a small incision and the surgeon can examine and repair the damaged joint.

Arthroscopic surgery

Minimally invasive surgery that is used in The Bonati Procedures to address a variety of back and neck pain problems that include herniated cervical, thoracic and lumbar discs; cervical, spinal or foraminal stenosis; degenerative disc disease, facet disease and nerve entrapment. The patented Bonati Procedures are arthroscopic or endoscopic techniques. In arthroscopic surgery, an arthroscope is inserted into a tiny incision. The surgeon is able to examine a joint using the arthroscope which consists of a tiny tube, a lens and a light source. The surgeon is also able to remove bits of bone, scar tissue or other bodies that may be causing a patient's pain. In the Bonati Procedures, intravenous sedation is used as an anesthetic, but other surgeons in other facilities may use general anesthesia for their procedures. Arthroscopic surgery is minimally invasive, which is why it is preferred by the surgeons at The Bonati Institute. It results in less trauma to the body, reduced bleeding and a quicker healing time.

Bone spur

Also known as an osteophyte, a bone spur is an outgrowth of calcium that forms as the body tries to compensate as bones in the spine or elsewhere move due to a variety of causes including disease or injury, or as the result of degenerative disc disease or spinal arthritis. Bone spurs typically develop as the body attempts to correct a problem. But, as they grow, they narrow the foramen of the vertebrae, pressing on nerves and ultimately causing spinal or foraminal stenosis. They usually end up limiting movement and causing pain.

Bulging disc

Discs are the shock-absorbing or cushioning bodies between the vertebrae of the spine. They consist of a thick, tough coating that surrounds a jelly-like material. When movement or an injury weakens the coating and causes it to bulge outward, the disk is said to be a ''bulging disc.'' Pain is caused when the bulge impinges on a nerve. Sometimes, the tough coating can actually tear, and the gelatinous material within the disc is released and presses on the spinal nerves. If this situation occurs in the lower back, sciatica may be the result. Sciatica is pain or numbness that travels from the lower back, through the buttocks, down the back of the thigh and even to the foot. Herniated discs are most often found in the lumbar spine since that is the area of the spine that is subject to the most stress and which supports most of the body weight.
Although some people use the terms ''bulging disc'' and ''herniated disc'' interchangeably, a bulging disc is one that does not have a tear in its tough coating, while a ''herniated disc'' does have a rupture or tear. Bulging discs often occur as a result of aging. As a person ages, the discs lose some flexibility and water content, and injury is more likely to occur. Also, the discs may develop some cracks and fissures. All of these situations make the discs more susceptible to injuries that cause bulging or tearing. Depending upon the individual and the situation, a bulging disc may not cause a problem. But bulging discs are more susceptible to herniation. Exercise, proper weight and good posture and body mechanics can help an individual to avoid disc problems. However, if you suspect you have a bulging or herniated disc, you should seek the advice of a physician. Depending upon your situation, your doctor may prescribe stretching exercises, massage therapy, medication or surgery.

Cannula

A slender, flexible tube that is inserted into a body cavity, duct or vessel. Along with an arthroscope and a trocar, a cannula is used in arthroscopic or endoscopic surgery.

CAT scan

CAT stands for Computerized Axial Tomography. Along with MRI images, CAT scans are helpful to diagnose a variety of problems that can cause back pain. A CAT scan can also be called a CT scan. A CAT scan is a diagnostic procedure in which cross-sectional or three-dimensional pictures of structures within the body are created by a computer. The machine merges the data from multiple X-ray images into pictures on a screen and allows some structures such as soft tissue that cannot be seen by X-rays to be examined. The scan is performed while a patient is lying on a narrow table that slides into the center of the scanner. While the patient is perfectly still, a thin E-ray beam rotates around the patient and small detectors measure the amount of X-rays that travel through the patient or the specific area of interest. Any movement will cause blurring of the pictures, so a technician will advise the patient when he or she must be completely still or when he or she may move. As the procedure occurs, the table moves at small intervals through the scanner so that various areas of the body can be studied. Some new scanners can study the body in one continuous motion, however. The X-rays are painless, but some patients may have trouble staying still for the time required for the test.

Cervical

Of or relating to the neck; the area of the spine that supports the skull. The cervical spine is comprised of seven vertebrae. Common problems of the cervical area include herniated cervical discs, cervical stenosis, cervical discectomy, cervical stenosis and cervical spondylosis. The cervical section of the spinal cord contains eight nerve roots which regulate breathing as well as movement of the neck, shoulders, arms and wrists.

Chronic pain

Pain that persists for a long period of time; some experts say it is pain that lasts longer than three months, while others say it is pain that lasts longer than six months. People who have suffered from failed open back surgeries, arthritis, degenerative disc disease, ruptured discs, whiplash, spinal fusion, sciatica, bone spurs, spinal stenosis, and a variety of other spine conditions may be acquainted with chronic pain. The National Institutes of Health suggests that up to 90 million Americans suffer from chronic pain. The institute notes that chronic pain in the costliest health problem in the United States, costing upward of $100 billion each year in treatment, lost time from work, pay-outs from insurance companies and legal bills. Chronic pain is usually associated with an underlying condition, according to experts and may be treated in a variety of ways. Its severity may be anywhere from mild to severe.

Compression

The act of applying pressure. When a vertebra or other area of the spine is injured and pushes on the soft disc, the resultant pressure causes the disc to compress, which can result in pain and often a suggestion of back or disc surgery. Too much compression on the disc can result in a bulging, herniated or ruptured disc.

Degenerative Disc Disease

Between the 32 vertebrae that make up the spine are structures called discs, which act like shock absorbers. The discs are made of a thick coating that surrounds a jelly-like material. Over time, the discs gradually deteriorate due to age, infection or injury. The gelatinous material may lose its ability to absorb water and the thick coating may weaken, stiffen, bulge or even rupture. The once flexible, supple disc becomes stiff and rigid and restricts movement and loses its cushioning ability. If the disc is compromised and impinges on nerves in the spinal column, pain can result. The most common early symptom of degenerative disc disease is pain in the back that spreads to the buttocks or upper thighs; however you should see a doctor to have the problem properly diagnosed and treated. Degeneration of the discs can lead to a variety of problems including cervical or lumbar spinal stenosis or spondylolisthesis.Degenerative disc disease may also be referred to as Degenerative Joint Disease.

Discectomy

The surgical procedure which results in the removal or excision of all or part of an intervertebral disc. Cervical or lumbar discectomies are more common than thoracic discectomies. A laser discectomy is one of The Patented Bonati Procedures. During this procedure, an arthroscope and lasers are used in minimally invasive surgery to remove the portion of the disc that is causing pain for the individual.

Endoscope

A thin, fiber-optic instrument that is inserted into a joint through an incision to examine, diagnose and treat health problems. It can also be called an arthroscope.

Facets

The smooth, flat surfaces of the vertebrae that interlock and allow the spine to flex yet still maintain its stability. The facet joints permit gliding movements between the vertebrae. The facets may become inflamed due to injury or age which can result in stiffness and/or pain. As the facet joints deteriorate, they might not align properly which can cause pain. Additionally, rubbing on the joints wears out the cartilage and fluid that lubricates them. As a result, bone can rub on bone, which results in painful back problems. The facets are compressed when an individual leans backward or to the side, so someone with a facet problem would more than likely feel pain in those positions. Leaning to the front reduces the stress on the facets, so a person with a facet problem would probably find relief in that position. Some experts believe that facet pain can weaken the muscles that help to strengthen the spine, which can lead to instability.Among the problems that affect facets are facet syndrome, facet disease and facet arthritis.
Facet Debridement - A procedure that is used to treat degenerative joint disease as a result of facet syndrome, facet disease or facet arthritis. Debridement is the surgical removal of torn, inflamed, damaged or dead tissue. Through minimally invasive spinal surgery, the physicians at The Bonati Institute perform facet debridement by using arthroscopes and lasers to vaporize irritated and painful nerves around the facets of the vertebrae. The Bonati Procedure uses specially designed probes and the Holmium YAG Laser to remove pain-inducing tissue in nerve branches above and below the affected facet joints on the spine. After a small incision is made, a tiny fiber optic camera is used to visualize the exact problem area and a laser is used to vaporize the painful nerves around the affected area. The Bonati Procedure usually takes about 10 minutes; most patients find immediate relief from their pain.

Failed Back Surgery Syndrome

Characterized by intractable pain and varying degrees of loss of function, failed back surgery syndrome is seen in more than half of patients who have had open back surgery. Most patients who have had open back surgery had hoped to find relief from a variety of back problems, but instead they discovered additional pain from resultant scar tissue and partial correction of their problem.

Foramenoplasty

A procedure in which the foramen of the vertebrae - the area of the vertebrae in which a nerve root exits the spine - is returned to its normal width after it has been narrowed due to degenerative disc disease or spinal arthritis. Bone spurs, stenosis or herniated discs may contribute to the narrowing of the foramen and a resulting foramenoplasty.

Herniated disc

A painful condition that occurs when the annulus or the cartilaginous material surrounding a vertebral disc ruptures or breaks. Herniated discs occur most often in the lumbar, or lower back, area of the spine. Although some people use the terms ''bulging disc'' and ''herniated disc'' interchangeably, a bulging disc is one that does not have a tear in its tough coating, while a ''herniated disc'' does have a rupture or tear. Herniated discs cause pain when the soft, jelly-like material within the disc leaks out and impinges on a spinal nerve. A bulging disc can turn into a herniated disc. Maintaining good health, observing proper body mechanics and exercising regularly can help individuals put off disc problems.

Herniated nucleus pulposis

A protrusion of the soft, gelatinous, inner disc material that results when an intervertebral disc is ruptured.

Holmium YAG Laser

A very small, powerful laser that is used for the intricate work required by arthroscopic surgery. The word 'laser' is an acronym for 'light amplification by stimulated emission of radiation.'' The Holmium YAG Laser is a versatile tool that can vaporize soft tissue as well as bone making it a perfect choice for use in the patented Bonati Procedures.

Hydrotherapy

The use of water in medical treatment. Hydrotherapy is an important part of the recovery period after a patient undergoes a patented Bonati Procedure. Exercising in water helps patients support weakened muscles while they work to regain range of movement, strength and normal function after neck or back surgery.

Laminectomy

A surgical procedure that relieves pressure on the spinal cord or nerve root that has been caused by a slipped disc or herniated disc in the lumbar spine or lower back region. The procedure is also used to treat spinal stenosis. It is designed to remove the bone or other matter that is putting pressure on a nerve and therefore causing an individual's pain.

Laser Arthroscopy

By using light as a source of energy, lasers vaporize unwanted materials. They are more precise than older surgical tools such as scalpels which are used in open spinal surgery. Lasers are used to remove calcium, scar tissue and bone from areas of the spine where they are not meant to be. Lasers can also be used to cauterize cervical, thoracic, lumbar, knee, shoulder and carpal tunnel areas.

Level

The space between two vertebrae in which a nerve may be compressed.

Lumbar

The area of the spine in which the five vertebrae of the lower back are located. The lumbar area is below the thoracic vertebrae and above the sacral vertebrae in the spinal column.

MAC Anesthesia

Anesthesia in which the patient is sedated yet conscious. MAC stands for Monitored Anesthesia Care. MAC Anesthesia is an important part of The Bonati Procedures since the patients are sedated to so they will feel less pain, yet awake enough to communicate to the surgical staff.

Microsurgery

Surgery on tiny body parts such as blood vessels. A camera magnifies the area that will be operated upon. The surgeon monitors the surgical site on a screen and operates using delicate instruments and precise techniques. Among the benefits of microsurgery are less trauma to the body and a quicker recuperative time.

Mild, Medium, Severe Compression

The level of intensity with which a nerve is compressed.

MISS

Minimally invasive spinal surgery that uses fiber optic tools and innovative techniques to address and repair problem areas. A small incision is made and an endoscope is inserted. Special tools are inserted into the endoscope and used to perform the surgery resulting in smaller incisions and less trauma to the surgical site.

MRI

Magnetic Resonance Imaging is of particular use in evaluating the areas of soft tissue, brain and spinal cord to determine the extent of problems. The images are three dimensional and are superior to traditional X-rays. MRI machines use magnets and radio waves to illustrate specific areas of the body. The test has become the method of choice for diagnoses in many instances because of the technician's ability to pinpoint exact areas for study. Among its many benefits is its ability to follow flowing blood throughout the body.

Myelogram

A test that helps to determine what areas of the spinal canal or which spinal nerves have been compromised and, as a result, are causing pain. During the procedure, a contrast material is injected into the spinal canal, which makes the spinal canal and spinal nerves more visible to the physician.

Nerve Block

A nerve block is the injection of a local anesthetic into a nerve, near a nerve plexus or in a pain trigger point. It works by interrupting pain sensory pathways and preventing information about pain from reaching the brain. Nerve blocks may help people suffering from sciatica and neck and back pain of various kinds including stenosis. Relief may last from several hours to days to even months depending on the problem and the individual. Nerve blocks may alleviate pain, but they generally do not treat the cause of the pain. Individuals on certain medications or with certain conditions are not candidates for nerve blocks, which should always be recommended by your physician.

Nerve Pathway

A nerve pathway may be ascending - bringing sensory information from the spinal cord to the brain - or descending - bringing information from the brain to the spinal cord to control movement of the body below the head.

Nerve Roots

The areas where the spinal nerves are connected to the spinal cord. Each nerve is connected in two areas: the anterior root and the posterior root.

Neurological

Having to do with the nerves or nervous system.

Neurosurgery

The branch of surgical medicine that treats the diseases and disorders of the brain, spinal cord and peripheral and sympathetic nervous systems.

Open back surgery

The traditional kind of back surgery that required long incisions, major trauma to the back and a long recuperative time. With the advent of arthroscopic surgery, many open back surgical procedures have fallen out of favor with patients looking for less invasive surgery with quicker recuperative times.

Orthopedics

The branch of medicine that is concerned with the skeletal system or the bones of the body.

Physiotherapeutics

Of, or relating to, physical therapy

Pinched nerve

When the spinal nerves are compromised so that they are not able to move freely within the spine's foramen, they are impinged or 'pinched.'' The compression on the nerve causes pain. There are a variety of ways that nerves can become 'pinched,'' including worn facet joints that compress on the nerves or bulging or herniated discs.

Radicular

Of, or pertaining to, nerve roots

Radiculopathy

Any disease of the spinal nerves or spinal nerve roots. It is also called radiculitis. The disease is characterized by pain that radiates from the spine and causes symptoms away from the spinal nerve root irritation. The disease is often caused by direct pressure on the nerve roots that shows up in areas of the skin that are controlled by the specific sensory fibers of the nerve roots.

Sciatic nerve

The largest nerve in the body, the sciatic nerve runs from the nerve roots in the lumbar part of the spinal canal and travels through the buttocks down to the legs. Pain that results from irritation of the sciatic nerve is called sciatica and is typically felt at the back of the thigh and radiating below the knee.

Sciatica

The pain that results from irritation of the sciatic nerve is called sciatica and is one of the most common causes of back pain. It is commonly caused by pressure on the sciatic nerve from a herniated disc. It is commonly suffered by people between the ages of 30 and 50 and will often disappear on its own. It generally is not caused by a specific incident, but often develops from years of wear and tear on the body.

Scoliosis

The disease refers to a sideways or lateral curvature of the spine. There are three causes of scoliosis - congenital or related to a problem during pre-natal development, neuromuscular or related to a problem of poor muscle control in tandem with another illness or idiopathic or of unknown cause.
It is most noticeable as one shoulder being higher than the other or in the tilting of the pelvis. The idiopathic form in adolescents is the most common, with the illness found more often in girls than boys.
Symptoms include the sideways curving of the spine, one shoulder higher than the other or a tilting of the pelvis, backache or lower back pain and fatigue. Diagnostic tests may include X-rays, MRIs and scoliometer measurements. Treatment often includes back braces.

Slipped disc

A rupturing of the shock-absorbing material that separates the vertebrae of the spine. See bulging disc or herniated disc.

Spinal fusion

The repair of an unstable portion of the spine by joining two or more vertebrae. The procedure is generally done surgically, but it may occur through traction or by immobilization. Pedicle screws, cages, plates and other devices may be used in the surgical procedure.
The most common area of the spine that is fused is the lumbar spine, but the cervical spine also can be fused. Depending upon the type of surgery, the incision may be made either on the back or through the chest.
The vertebrae are fused with bone grafts and may or may not have pedicle screws and cages and other devices.

Spinal stenosis

A narrowing of the cervical or lumbar spinal canal which causes compression on the nerve roots and therefore pain in the affected areas. It generally affects middle-aged or elderly people and is usually caused by osteoarthritis or Paget's Disease or by an injury. Symptoms include pain in the buttocks, thighs or calves that gets worse with standing, walking or exercise; back pain that radiates to the legs, weakness of the legs, neck pain, back pain and imbalance while walking .If conservative treatment including medications fails to help, then surgery may be suggested. The surgical procedure opens the spinal canal to remove the pressure on the nerve roots.

Spondylolisthesis

The forward movement of one vertebra over an adjacent vertebra. In adults the most common cause is degenerative disc disease. Other causes may be stress fractures and injury. It may be associated with osteoporosis and may range from mild to severe. Symptoms may include lower back pain, pain in the thighs and buttocks, stiffness and muscle tightness.

Thoracic

The thoracic area of the spine is below the cervical area and above the lumbar area. There are 12 thoracic vertebrae. They are represented by the symbols T-1 through T-12.