Term/Abbrev. Definition
Acidity Having a pH (chemistry symbol for the potential of Hydrogen, which is a measure of the acidity or alkalinity of a solution) that is lower than 7.0
Acupuncture Practice of inserting needles into the skin at points (Meridians) of the body to help relieve pain and treat illness
Addiction Psychological, emotional, physical need for a drug, associated with cravings and inappropriate efforts to obtain the drug
AFGI Abbreviation for “Aspiration &Fibrin Glue Injection” (This abbreviation is not a standardized medical abbreviation, but one that patients have used to abbreviate; it has also been called FGI, but that abbreviation is too abbreviated in that it eliminates the first part of the procedure, the aspiration of the spinal fluid, before fibrin glue is injected.) The procedure is used for treatment of Tarlov cysts by first aspirating the cerebrospinal fluid (CSF) from the Tarlov cyst(s) and then injecting fibrin glue as a sealant to occlude the neck of the cyst and prevent CSF from further refilling the cyst. This procedure is performed by an Interventional Neuroradiologist, and sometimes with the assistance of a Neurosurgeon to guide the Neuroradiologist via CT guided fluoroscopy.
Alkalinity Having a pH(chemistry symbol for the potential of Hydrogen, which is a measure of the acidity of alkalinity of a solution) that is higher than 7.0
Analgesic A drug or medicine given to reduce pain without resulting in loss of consciousness. Analgesics are sometimes referred to as painkiller medications. There are many different types of analgesic medications available in both prescription and over the counter types. For further information, you might wish to go to the pain dictionary in the website library.
Anterior Before or in front of; the opposite of posterior. Anterior approach in spine surgery refers to an approach through the front of the neck or through the abdomen.
Antidepressant A drug used to prevent or treat depression. Some anti-depressant medications are known to act also as analgesics (pain reliever meds), especially for some forms of neuralgia (nerve pain)

The available antidepressant drugs include the SSRIs or selective serotonin reuptake inhibitors, MAOIs or monoamine oxidase inhibitors, tricyclic antidepressants, tetracyclic antidepressants, and others.

The SSRIs (selective serotonin reuptake inhibitors) include:

· citalopram (Celexa, Cipramil)

· escitalopram oxalate (Cipralex, Lexapro)

· fluvoxamine maleate (Luvox)

· paroxetine (Paxil, Seroxat, Aropax)

· fluoxetine (Prozac)

· sertraline (Zoloft, Lustral)

The MAOIs (monoamine oxidase inhibitors) include:

· phenelzine (Nardil)

· tranylcypromine (Parnate)

The tricyclic antidepressants include:

· amitriptyline (Elavil, Endep)

· clomipramine (Anafranil)

· desipramine (Norpramin, Pertofrane)

· doxepin (Adapin, Sinequan)

· imipramine (Tofranil)

· nortryptyline (Pamelor)

· protriptyline (Vivactil)

· trimipramine (Surmontil)

The tetracyclic antidepressant is maprotiline (Ludiomil).

Other antidepressant drugs include:

· bupropion (Wellbutrin)

· buspirone (Buspar)

· duloxetine (Cymbalta)

· mirtazapine (Remeron, Zispin, Avanza, Norset, Remergil)

· nefazodone (Serzone)

· reboxetine (Edronax, Vestra)

· trazodone (Desyrel)

· venlafaxine (Effexor)

Antiseizure A classification of medications that helps to prevent seizures; they also have potential benefit in treating nerve pain. Two of the most common medications used for the treatment of nerve pain are gabapentin (Neurontin) and pregabalin (Lyrica)

Antiseizure medications by chemical and brand name:

Carbamazepine, aka Tegretol

Clonazepam, Klonopin

Clorazepate, aka Tranxene

Divalproex, aka Depakote

Gabapentin, aka Neurontin

Levetiracetam, Keppra

Lamotrigine, aka Lamictal

Oxcarbazepine, Trileptal

Pregabalin, aka Lyrica

Tiagabine, aka Gabitril

Topiramate, aka Topamax

Valproate Sodium, aka Depacon

Zonisamide, aka Zonegran

Arachnoid Middle layer of the 3 membranes (meninges) that cover the brain and spinal cord
Arachnoiditis Arachnoiditis is a debilitating condition characterized by severe stinging and burning pain and neurologic problems. It is caused by an inflammation of the arachnoid lining – one of the 3 linings that surround the brain and spinal cord. This inflammation causes constant irritation, scarring, and binding of nerve roots and blood vessels. The predominant symptom of arachnoiditis is chronic and persistent pain in the lower back, lower limbs or, in severe cases, throughout the entire body. Other symptoms may include:

Tingling, numbness, or weakness in the legs,bladder dysfunction,severe shooting pain (which some compare to an electric shock sensation). Most people with arachnoiditis are unable to work and have significant disability. This disorder can be very debilitating, as the pain is constant and intractable.

Aspiration Removal of fluid and cells through a needle.
Asymptomatic Without symptoms (the prefix “a” means in the absence of or without)
Autoimmune A misdirected immune response that occurs when the immune system goes awry and attacks the body itself. Autoimmune diseases occur when there is a progression of this process. Some autoimmune diseases are lupus, Ehler’s Danlos, scleroderma, Sjogren’s, Marfan syndrome.
Biofeedback Biofeedback is an electronic means of measuring and controlling certain on-going body functions such as muscle tension, skin temperature, and heart rate, which were once thought to be “involuntary” or not under an individual’s control. The development of techniques such as biofeedback makes it possible, without drugs, to gain control over these physiological functions, many of which change dramatically under stressful conditions.
Bladder A membranous sac or receptacle for a secretion, as in the urinary bladder
Blood Patch An epidural blood patch is a relatively simple procedure in which blood drawn from an intravenous line in the arm is injected into the epidural space in the spine. This procedure is commonly done to treat spinal headaches, usually resulting from a loss of CSF following a lumbar puncture or myelogram. This type of headache is positional in nature, usually worsened by sitting or standing and relieved by lying down. Placement of the blood forms a barrier within the epidural space to seal off the leak.

The injection is done with the patient lying on his or her abdomen. Fluoroscopy (live x-ray) is used to aid the radiologist in guiding the needle directly into the epidural space. Once the needle has reached the epidural space, a small amount of contrast dye is injected into the area to ensure proper needle placement and then the blood is injected.

Following the procedure, the patient is expected to lie flat for approximately an hour, after which time the patient is discharged with instructions to rest at home.

Bone scan A bone scan is a test that detects areas of increased or decreased bone metabolism. The test is performed to identify abnormal processes involving the bone such as tumor, infection, or fracture. A radiotracer (a bone-seeking radioactive material) is injected into a vein, so it travels through the bloodstream. As the material wears away, it gives off radiation. This radiation is detected by a camera that slowly scans your body. The camera takes pictures of how much radiotracer collects in the bones. If a bone scan is done to see if you have a bone infection, images will be taken shortly after the radioactive material is injected, as well as 3 to 4 hours later, when it has collected in the bones. This is called a 3-phase bone scan.
Catheterize Passage of a small catheter (tube) into a body cavity for the purpose of drainage as in catheterization or drainage of the urinary bladder, or for insertion of a contrast medium for a diagnostic test
CAT scan or CT Computerized Axial Tomography (CAT) or CT scanning uses special X-ray technology to obtain image data from different angles around the body and then uses computer processing of the information to show a cross section of body tissues and organs. Radiologists interpreting the images can then view the organs in cross section.
Cauda equina Cauda equina (horse’s tail) is so-called because of its appearance. It is found at the lower end of the spinal cord. The spinal cord is shorter than the spinal (vertebral) canal in which it runs, ending at the approximate level of the first or second lumbar vertebra (this may vary in different people). The cauda equina contains the nerve roots from L1-5 and S1-5. Nerve roots L4-S4 join in the sacral plexus which gives rise to the largest nerve in the body, the sciatic nerve. The sacral plexus is also involved in sensory and motor nerves to and from the anal and genital regions. The nerve roots emerge in pairs from the relevant vertebral foramen (hole)


The upper spine (neck) area of the vertebral column. This section consists of seven vertebra, and are referred to as C1-C7. These vertebrae are smaller in size when compared to other spinal vertebrae. The purpose of the cervical spine is to contain and protect the spinal cord, support the skull, and enable diverse head movement ( rotate side to side, bend forward and backward).

Spinal Cord and Cervical Nerve Roots
Nerve impulses travel to and from the brain through the spinal cord to a specific location by way of the peripheral nervous system (PNS). The PNS is the complex system of nerves that branch off from the spinal nerve roots. These nerves travel outside of the spinal canal or spinal cord into the organs, arms, legs, fingers – throughout the entire body.

Injury or mild trauma to the cervical spine can cause a serious or life-threatening medical emergency Pain, numbness, weakness, and tingling are symptoms that may develop when one or more spinal nerves are injured, irritated, or stretched. The cervical nerves control many bodily functions and sensory activities.

C1: Head and neck
C2: Head and neck
C3: Diaphragm
C4: Upper body muscles (e.g. Deltoids, Biceps)
C5: Wrist extensors
C6: Wrist extensors
C7: Triceps
C8: Hands

Chiari Malformation Chiari malformations (CMs) are structural defects in the cerebellum, the part of the brain that controls balance. When the indented bony space at the lower rear of the skull is smaller than normal, the cerebellum and brainstem can be pushed downward and protrude through the foramen magnum (the opening at the base of the skull through which the spinal cord passes). The resulting pressure on the cerebellum and the spinal cord can block the flow of cerebrospinal fluid (the liquid that surrounds and protects the brain and spinal cord) and can cause a range of symptoms including dizziness, muscle weakness, hoarseness, numbness, vision problems, headache, and problems with balance and coordination.
Clinical Trials
Organized studies that test the value of various treatments, such as drugs or surgery, in human beings. They are only conducted on a limited basis and with the approval of IRB (Internal Review Boards), which are committees that approve, monitor, and regulate the activities of the trials, as well as report the results. All patients involved are informed and sign permits to be involved in the clinical trials.
Coccydynia Pain in the coccyx (tailbone) or end of the spinal column
Coccyx Small bone at the base of the spinal column formed by four fused vertebrae; also referred to as the “tailbone”


Congenital Present at birth
Connective tissue disorders A disease (autoimmune or otherwise) ,such as Lupus, Ehler’s-Danlos, or Marfan’s that attacks the collagen or other components of connective tissue (the material between the cells of the body that gives tissues form and strength).
Contralateral Originating in or affecting the opposite side of the body; for example, a Tarlov cyst may be present on the right side, but the patient’s symptoms such as pain and paresthesias are on the left side
Contrast media
A dye or radiopaque substance used during an x-ray study to provide a contrast in density (thickness) between the tissue or organ being filmed and the media.The contrast media improves visualization of specific tissues and organs.
Conus medullaris The conus medullaris is the terminal end of the spinal cord. It occurs near lumbar vertebral levels 1 (L1) and 2 (L2). After the spinal cord tapers out, the spinal nerves continue as dangling nerve roots called cauda equina. This terminal nerve root tail is referred to as the filum terminale. The upper end of the conus medullaris is usually not well defined
Cortisone A hormone that is sometimes used as an anti-inflammatory agent
Craniosacral therapy A treatment in alternative medicine that identifies and reduces restrictions in movement of the dural sheath and in the flow of cerebrospinal fluid as a means of restoring well-being.Biodynamic Craniosacral Therapy takes a whole-person approach to healing and the inter-connections of mind, body and spirit are deeply acknowledged. It is an effective form of treatment for a wide range of illnesses helping to create the optimal conditions for health, encouraging vitality and facilitating a sense of well-being. It is suitable for people of all ages including babies, children and the elderly, and can be effective in acute or chronic cases.
CSF Cerebrospinal Fluid. The clear fluid that surrounds the brain and spinal cord, and acts as a shock absorber to prevent injury to them. CSF is manufactured in the ventricles of the brain. The CSF contains nutrients and proteins necessary for the nourishment and normal function of the brain; it also carries away waste products from surrounding tissues. The CSF flows between the cranium (skull) and spine to compensate for changes in intracranial blood volume. The balance between the production and absorption of CSF is critically important. The abnormal accumulation of fluid is due to a disturbance in the production or absorption of CSF, or to a blocked flow of CSF.
Cyst Abnormal closed sac-like structure within a tissue that contains a liquid, gas, or semi-solid substance. Cysts can occur anywhere in the body and can vary in size. The outer portion of a cyst is termed the cyst wall.
Cystitis An infection of the bladder. It causes burning sensations during urination and a frequent need to urinate. It is caused by bacteria settling in the bladder due to several reasons, including the inability to completely empty the bladder when urinating. This is called urinary retention.
DDD Degenerative disc disease is a misnomer. A large part of many patients’ confusion is that the term “degenerative disc disease” sounds like a progressive, very threatening condition. However, this condition is not strictly degenerative and is not really a disease. Part of the confusion probably comes from the term “degenerative”, which implies to most people that the symptoms will get worse with age. The term applies to the disc degenerating, but does not apply to the symptoms. While it is true that the disc degeneration is likely to progress over time, the low back pain from degenerative disc disease usually does not get worse. Another source of confusion is probably created by the term “disease”, which is a misnomer. Degenerative disc disease is not really a disease at all, but rather a degenerative condition that at times can produce pain from a damaged disc.

Disc degeneration is a natural part of aging and over time all people will exhibit changes in their discs consistent with a greater or lesser degree of degeneration. However, not all people will develop symptoms. In fact, degenerative disc disease is quite variable in its nature and severity.

Dependency The situation where a patient may come to feel the absolute need for a drug (psychological dependency) or will experience withdrawal symptoms if the drug is taken away (physical dependency).
An area of skin supplied by fibers of a single nerve root
DEXA scan Dexa stands for ‘Dual Energy X-ray Absorptiometry’. It is most often referred to as a Bone Density test. It is the most commonly used test for measuring bone mineral density. It is one of the most accurate ways to diagnosis Osteopenia or Osteoporosis.
Dilation or dilatation

The process of enlargement, stretching, or expansion.

Disc/Disk A flat round platelike structure. Discs separate the bones that make up the spinal column. They are fibrous structures filled with a pulpy, gelatinous matter(nucleus pulposus). They function as shock absorbers for the spine. Disc-related injuries to the back can be associated with deformation of the discs, including bulging and rupturing of the discs.

Discography A diagnostic tool to determine if a disc is causing pain. Discography is usually performed in a procedure room that has equipment for X-ray imaging of the discs as the test is performed. You will be asked to lay on one side and may be rolled slightly forward on a table. Pillows can be used to help you achieve the desired position. Your skin will be wiped at the site of the injection with a cleansing antiseptic agent. Typically, the lowest two or three lumbar disc levels are injected. The health care provider may inject an anesthetic into the skin to reduce the pain of the needles passing through tissue. In some cases, antibiotics are given intravenously before and after the procedure. A needle is inserted through the skin and muscle and comes to rest on the outer layer of the disc. During the process of placing the needles, imaging studies called fluoroscopy (similar to X-ray) are used to help the health care provider see where the needles are located along the path to the disc. A second needle is passed through the first one and into the center of the disc. This process is repeated at each level that is to be injected. In some cases, the health care provider may decide to inject an additional level and will place needles at that location after the initial injections. Contrast (a liquid that shows up on X-ray), is injected into the center of each disc. If the disc is normal, the contrast remains in the center of the disc. If the disc is abnormal, the contrast spreads through the tears in the disc. As each disc is injected, you may be asked to rate the intensity of the pain that the injection causes, if any. You may also be asked if the pain is similar to your usual symptoms in terms of location and the type of pain you are experiencing. This procedure is repeated for each disc that is injected. The pain provoked by the injection should be temporary. CT scanning is often performed after disc injection. This gives your health care provider more information about the exact pattern of the spread of the contrast through or out of the disc. Widespread disc degeneration is identified by the contrast spreading throughout the disc space.
Dura mater Literally means “hard mother” in Latin. It is the outermost, toughest, and most fibrous of the three membranes (meninges) covering the brain and spinal cord, and is usually simply referred to as dura.
Dural Ectasia (Ecstasia) A widening of the spinal canal
Dural sheath An extension of the dura mater that envelops the roots of spinal nerves
EMG Electromyogram is a medical test that measures muscle response to electric nerve stimulation to the muscles; EMG is performed using an instrument called an electromyography, to produce a graphic record of the nerve stimulation to muscles. “Myo” is a medical term meaning muscle.
Epidural Outside the dura, which is the outermost, toughest, and most fibrous of the three membranes (meninges) covering the brain and the spinal cord.
ESI Epidural Steroid Injection

An epidural steroid injection places a powerful anti-inflammatory medication directly around the spinal nerves. To administer the epidural steroid injection, your doctor will have you lie flat, face down, on an x-ray table. Using the x-ray to visualize the location of the tip of the needle, your doctor will guide the needle to an area very near to the spinal nerves, called the epidural space. Using the x-ray improves the chance the medication will be given in the proper location. The epidural steroid injection lasts about 15 minutes, and light sedation may be used if needed.

Epidural steroid injections may be given by many types of physicians, including anesthesiologists, orthopedic surgeons, neurologists, interventional radiologists, and others trained in this technique. Usually a series of injections, often three, each spaced a week apart, are given. With this schedule, many patients find relief of symptoms within a few weeks. Often this helps control the inflammatory process and may provide long-lasting relief.

Side-effects from epidural steroid injections are rare, but should be discussed. These include:

Infection: Very unusual (less that 0.5%), and usually avoided by using a sterile technique.

Bleeding: Also unusual, and avoided by not performing this procedure on patients with bleeding disorders or those on blood thinning medication.

Dural Tears: Caused by piercing the sac around the spinal nerves with the needle. This usually results in a headache.

Increased Blood Sugar: Diabetics must carefully monitor their blood sugar after this or any other steroid injection.

Other side-effects are possible, and should be discussed prior to injection with the doctor performing this procedure.

Etiology Cause
Facet A small smooth area on a bone
Fenestration A surgical term meaning to make an artificial opening, as in the fenestration/imbrication procedure, to create slices into a Tarlov cyst to drain the spinal fluid before packing with fat and glue (imbrication)
FGI or AFGI A more accurate acronym is AFGI, to denote aspiration and then fibrin glue injection. Neither acronym is recognized in the standardized, universally recognized medical abbreviations. In this case it is shortened for “Aspiration &Fibrin Glue Injection”. The procedure is used for treatment of Tarlov cysts by first aspirating the CSF(cerebrospinal fluid) from the Tarlov cyst(s) and then injecting fibrin glue as a sealant to occlude the neck of the cyst and prevent CSF from further refilling the cyst. This procedure is performed by an Interventional Neuroradiologist, and sometimes with the assistance of a Neurosurgeon to guide the Neuroradiologist via CT guided fluoroscopy.
Fibrin glue Fibrin sealants are a type of surgical tissue adhesive derived from human and animal blood products. The ingredients in these sealants interact during application to form a stable clot composed of a blood protein called fibrin. Fibrin sealants are also called fibrin glues.
Filum This is a thin piece of tissue that comes from the end of the spinal cord and goes to the coccyx (tail bone). It is also referred to as “filum terminale”. Sometimes there is too much fat in the filum, or the filum is too tight; both of these things can cause a tethered cord.
Foramen Hole or opening
Foramen magnum Opening of the occipital bone (at the base of the skull) through which the spinal cord passes from the brain
Fluoroscopy A type of medical imaging that shows a continuous x-ray image on a monitor, much like an x-ray movie. It is used to diagnose or treat patients by displaying the movement of a body part or of an instrument or dye (contrast agent) through the body.
Herpes Simplex Virus Herpes simplex virus type 1 (HSV-1) is usually associated with infections of the lips, mouth, and face. It is the most common herpes simplex virus and is usually acquired in childhood. HSV-1 often causes lesions inside the mouth such as cold sores (fever blisters) and is transmitted by contact with infected saliva. By adulthood, up to 90% of individuals will have antibodies to HSV-1. Herpes simplex virus 2 (HSV-2) is sexually transmitted. Symptoms include genital ulcers or sores. In addition to oral and genital lesions, the virus can also lead to complications such as meningoencephalitis (infection of the lining of the brain and the brain itself) or cause infection of the eye — in particular the conjunctiva, and cornea. However, some people have HSV-2 but do not display symptoms. Up to 30% of U.S. adults have antibodies against HSV-2.
HNP Herniated Nucleus Pulposus: medical terminology for herniated vertebral disc. The soft, fibro cartilaginous, gel-like central portion of the intervertebral disc that serves as a “shock absorber cushion” in the disc. The discs may herniate, rupture, or move out of place due to injury or strain on the discs.
IBS Irritable Bowel Syndrome is also known as spastic colon. The signs and symptoms of irritable bowel syndrome can vary widely from person to person and often resemble those of other diseases. Among the most common are: abdominal pain or cramping, a bloated feeling, gas (flatulence), diarrhea or constipation; people with IBS may also experience alternating bouts of constipation, diarrhea, and mucus in the stool. No one knows exactly what causes irritable bowel syndrome. The walls of the intestines are lined with layers of muscle that contract and relax as they move food from your stomach through your intestinal tract to your rectum. Normally, these muscles contract and relax in a coordinated rhythm. But if you have irritable bowel syndrome, the contractions are stronger and last longer than normal. Food is forced through your intestines more quickly; however, sometimes the opposite occurs, the contractions as less strong, food passage slows, and stools become hard and dry .Some researchers believe IBS is caused by changes in the nerves that control sensation or muscle contractions in the bowel. In the case of damaged or irritated sacral nerve roots at S2, S3, this could be a problem in patients with Tarlov cysts.
IC Interstitial cystitis (IC) is a condition that results in recurring discomfort or pain in the bladder and the surrounding pelvic region. The symptoms vary from case to case and even in the same individual. People may experience mild discomfort, pressure, tenderness, or intense pain in the bladder and pelvic area. Symptoms may include an urgent need to urinate (urgency), a frequent need to urinate (frequency), or a combination of these symptoms. Pain may change in intensity as the bladder fills with urine or as it empties. Women’s symptoms often get worse during menstruation.
Imbrication A surgical term meaning to make overlaps or layers. This procedure is used in the surgical treatment of Tarlov cysts in the process of overlapping layers of fat and glue, after the cysts have been fenestrated(sliced) and drained of spinal fluid.
Incontinence Inability to retain urine or feces through loss of sphincter control, or because of spinal lesions or spinal nerve damage
Inflammation A basic way by which the body reacts to infection, irritation, or other injury causing the possible symptoms of pain and swelling
Interventional Neuroradiologist An accredited medical subspecialty centered on minimally invasive image-based technologies/procedures used to diagnosis and treat diseases of the head, neck, and spine. Abbreviated as INR
Intractable Difficult to alleviate, remedy, or cure, as in intractable pain
Kegel Kegel exercises are designed to strengthen the pelvic floor muscles that surround the openings of the urethra, vagina and rectum.
Laminectomy A surgical procedure to remove a portion of a vertebra, called the lamina, under which one finds the ruptured disk that is pushing on nerves and causing pain and dysfunction. The ruptured disk is then removed. In other instances the lamina is removed because of pressure caused by bony spurs or other pathology.
Lordosis An abnormal forward or inward curvature of the spine in the lumbar region
LP Lumbar Puncture. Also referred to as a “spinal tap”. This procedure is done for diagnostic purposes to obtain spinal fluid for lab analysis. It is also a procedure done prior to a myelogram, as a mechanism for injecting contrast material (dye) into the spinal fluid, so that anatomical abnormalities can be more clearly seen.
Lumbar Pertains to the abdominal segment of the torso, between the diaphragm and the sacrum (pelvis) The five vertebrae in the lumbar region of the back are the largest and strongest in the spinal column.
Marfan Syndrome Marfan syndrome is an inherited disorder of the connective tissue that causes abnormalities of the patient’s eyes, cardiovascular system, and musculoskeletal system. Marfan syndrome is sometimes called arachnodactyly, which means “spider-like fingers”, since one of the characteristic signs of the disease is disproportionately long fingers and toes. It is estimated that one person in every 3000-5000 has Marfan syndrome, or about 50,000 people in the United States. Marfan syndrome is one of the more common inheritable disorders.

Marfan syndrome affects three major organ systems of the body: the heart and circulatory system, the bones and muscles, and the eyes. The genetic mutation responsible for Marfan syndrome was discovered in 1991. It affects the body’s production of fibrillin, which is a protein that is an important part of connective tissue. Fibrillin is the primary component that allow tissues to stretch repeatedly without weakening. Because the patient’s fibrillin is abnormal, his or her connective tissues are looser than usual, which weakens or damages the support structures of the entire body.

The most common external signs associated with Marfan syndrome include excessively long arms and legs, with the patient’s arm span being greater than his or her height. The fingers and toes may be long and slender, with loose joints that can be bent beyond their normal limits. This unusual flexibility is called hypermobility. The patient’s face may also be long and narrow, and he or she may have a noticeable curvature of the spine. It is important to note, however, that Marfan patients vary widely in the external signs of their disorder and in their severity; even two patients from the same family may look quite different. Most of the external features of Marfan syndrome become more pronounced as the patient gets older, so that diagnosis of the disorder is often easier in adults than in children. In many cases, the patient may have few or very minor outward signs of the disorder and the diagnosis may be missed until the patient develops vision problems or cardiac symptoms.

Massage Systematic, scientific manipulations of body tissues with the hands to relieve pain and reduce swelling, relax muscles, and speed healing after strains and sprains. It has been used for more than 3,000 years by the Chinese. Early in the 19th century, the Swedish physician Per Henrik Ling (1776 – 1839) devised a massage system for joint and muscle ailments, which were later, extended to relieve deformities of arthritis and re-educate muscles following paralysis. Manipulations include light or hard stroking, compression (kneading, squeezing, and friction), and percussion (striking with the edges of the hands in rapid alternation).

Massage for the patient with Tarlov cysts should be a gentle massage and particularly around the sacral area.

Meninges The three layered membranes (pia mater, arachnoid mater, and dura mater) that surround the brain and spinal cord

Diagram of Vertebra, Meninges and Spinal cord

Meningocele A protrusion of the meninges through an opening in the vertebral column. A meningocele contains only cerebrospinal fluid and no neural tissue.
MRI Magnetic Resonance Imaging. MRI is a diagnostic imaging tool that produces detailed images of the human body without ionizing radiation or X-rays. These images are created using a large magnet, radio waves and computers.
MRN Magnetic Resonance Neurography is the imaging of nerves through the use of magnetic resonance equipment. But MR neurography is more than just placing a person underneath an MR machine and taking a picture; it is a patented process that requires specific MR equipment and patented configurations, skilled personnel to perform the imaging, computer-aided visual enhancements, and trained neuroradiologists and neurosurgeons to “read” (or knowledgeably interpret) the scans to properly identify issues and provide diagnoses and recommended courses of action.
Myelogram A myelogram is a special x-ray examination to study the spinal canal, spinal cord and the area surrounding it, which is called the subarachnoid space. The procedure involves the injection of contrast material or dye into the spinal canal. A myelogram can identify abnormalities of the spinal cord, the spinal canal within which it sits, and the spinal nerve roots connected to it. Myelography is often performed when other exams such as computerized tomography (CT) scans or magnetic resonance imaging (MRI) have not provided enough information for an accurate diagnosis to be made.
Narcotic An addictive drug, such as opium, that reduces pain, alters mood and behavior, and usually induces sleep or stupor. Natural and synthetic narcotics are used in medicine to control pain.
NCV Nerve conduction velocity (NCV) is a test that determines the speed of conduction of impulses through a nerve. The nerve is stimulated, usually with surface electrodes, which are patch-like electrodes placed on the skin over the nerve at various locations. One electrode stimulates the nerve with a very mild electrical impulse. The resulting electrical activity is recorded by the other electrodes. The distance between electrodes and the time it takes for electrical impulses to travel between electrodes are used to calculate the nerve conduction velocity.
Nerve Blocks The injection of a nerve numbing substance around a group of nerves (plexus or ganglion) that cause pain to a specific organ or body region. There are different types of nerve blocks used for different purposes: “Therapeutic” nerve blocks are used to treat painful conditions. They contain local anesthetic that can be used to control acute pain. “Diagnostic” nerve blocks are used to determine sources of pain; these blocks typically contain an anesthetic with a known duration of relief. “Prognostic” nerve blocks predict the outcomes of given treatments. For example, a nerve block may be performed to determine if more permanent treatments (such as surgery) to block the activity of a nerve would be successful in treating pain. The medications that are injected include local anesthetics, steroids, and opioids.
Nerve root The start of the nerve as it leaves the spinal cord and passes through the left and right foramen to serve an area of the body. Diagram shows the Sacral nerves at S2, S3, and S4 that effect the intestines, bladder, and reproductive organs.

Neuralgia Nerve Pain
Neuritis Inflammation of a nerve
Neurogenic Originating from nerve tissue
Neuropathy The name given to a group of disorders involving nerves. Symptoms range from a tingling sensation or numbness in the toes and fingers to paralysis.
Neuropathic pain Pain initiated or caused by a primary lesion or dysfunction in the nervous system. It is characterized by spontaneous pain described as burning, cramping, constant
NR Neuroradiologist – A physician who specializes in the branch of radiology that deals with the nervous system
NS Neurosurgeon. A physician who has specialized in surgical procedures involving brain, spinal cord and nervous system.
NSAID Non Steroidal Anti-Inflammatory Drug – There are 2 types of prescription and OTC (over the counter) NSAIDs

Traditional NSAIDs include the following:

Diclofenac (brand names: Cataflam, Voltaren)

Etodolac (brand name: Lodine)

Fenoprofen (brand name: Nalfon)

Flurbiprofen (brand name: Ansaid)

Ibuprofen ( brand names: Advil, Motrin)

Indomethacin (brand name: Indocin)

Ketoprofen (brand names: Orudis, Oruvail)


Meloxicam (brand name: Mobic)

Nabumetone (brand name: Relafen)

Naproxen (brand names: Anaprox, Naprelan, Naprosyn)

Oxaprozin (brand name: Daypro)

Piroxicam (brand name: Feldene)

Sulindac (brand name: Clinoril)

Tolmetin (brand name: Tolectin)

COX-2 inhibitors include celecoxib (brand name: Celebrex)

NTD Neural tube defect; defects in the spinal cord ranging from conditions such as spina bifida, tethered cord, myelomeningocele
Opiate Any drug containing or derived from opium
Osteoporosis A decrease in bone mass and bone density and an increased risk and/or incidence of fracture
Pain A sensation in which a person experiences discomfort, distress, or suffering due to provocation of sensory nerves. Chronic pain is defined as pain that lasts longer than 3 months.

Pain management

Pain management  is the discipline concerned with the relief of pain.

Acute pain, such as that which occurs with trauma, often has a reversible cause and may require only transient measures and correction of the underlying problem. In contrast, chronic pain results from conditions that are difficult to diagnose and treat, and that may take a long time to reverse. Some examples include cancer, neuropathy and referred pain. Pathways are set up to continue to transmit the sensation of pain even though the underlying condition or injury that originally caused pain has been healed. In such situations, the pain itself is frequently managed separately from the underlying condition of which it is a symptom, or goal of treatment is to manage the pain with no treatment of any underlying condition , if the underlying condition has resolved or if no identifiable source of the pain can be found.

Pain management generally benefits from a multidisciplinary approach that includes pharmacologic measures (analgesics such as narcotics or NSAIDs and modifiers,such as tricyclic antidepressants or anticonvulsants), non-pharmacologic measures (such as interventional procedures, physical therapy and physical exercise, application of ice and/or heat), and psychological measures (such as biofeedback and cognitive therapy).

Pain management practitioners come from all fields of medicine. Most often, pain fellowship trained physicians are anesthesiologists, neurologists, physiatrists or psychiatrists. Some practitioners focus more on the pharmacologic management of the patient, while others are very proficient at the interventional management of pain. Interventional procedures typically used for chronic back pain  include: epidural steroid injections, facet joint injections, neurolytic blocks, Spinal Cord Stimulators (SCS) and intrathecal drug delivery system implants, etc. Over the last several years the number of interventional procedures done for pain has grown to a very large number


Swelling of the optic disc, visible on ophthalmoscopic examination of the fundus of the eye, caused by increase in intracranial pressure. The meningeal sheaths that surround the optic nerves from the optic disc are continuous with the meninges of the brain; therefore increased intracranial pressure is transmitted forward from the brain to the optic disc in the eye to cause swelling.

Paresthesia An abnormal sensation, such as numbness, tingling, prickling, burning, or creeping on the skin that has no objective cause. Paresthesia is the usual American spelling and paraesthesia the preferred English spelling. Pronounced par·es·the·sia. From the Greek para (abnormal) + esthesis (feeling) = an abnormal feeling.
Pathology The scientific study of the nature of disease and its causes, processes, development, and consequences
Perineural Around a nerve or group of nerves
Peritoneal Having to do with the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen)
pH A chemistry symbol for the potential of Hydrogen, which is a measure of the acidity or alkalinity of a solution. Solutions with a pH less than seven are considered acidic, while those with a pH greater than seven are considered basic (alkaline).
PHN Post Herpetic Neuralgia – Medical term for an eruption of the herpes zoster virus that has been lying dormant in the nervous system. It is more commonly referred to as “shingles”. The lesions of shingles usually appear around the lower trunk/waistline and can be very painful.
Pia mater The delicate and highly vascular innermost layer of the three meninges (membranes covering the brain and spinal cord) It is a translation from latin meaning “tender mother”.
Piriformis (muscle and syndrome) The piriformis muscle is flat, pyramid-shaped, and oblique (slanted). This muscle originates to the anterior of the S2-S4 vertebrae, the sacrotuberous ligament, and the upper margin of the greater sciatic foramen. This muscle passes through the greater sciatic notch and inserts on the superior surface of the greater trochanter(bony bump) of the femur(large bone in the upper leg). With the hip extended, the piriformis muscle is the primary external rotator; however, with the hip flexed, the piriformis muscle itself becomes a hip abductor (Muscle which when activated, normally moves an extremity or limb away from the body). Piriformis syndrome is pain in the hip, buttocks, or thigh. It is caused by pressure on the piriformis muscle in the hip. The pain is a deep ache and gets worse with exercise or sitting for long periods. In 10% of the population the sciatic nerve passes through the piriformis instead of under it as normal. Conditions which cause the muscle to become short and contracted increase the nerve compression. Not all cases are due to the nerve passing through the muscle.


Posterior Toward the rear or back; opposite to anterior
Prognosis The probable outcome of a disease
Radiculopathy The irritation of a nerve root; radiculopathies can cause pain and/or neurologic deficits
Resection A partial excision or cutting off of a part surgically
Residual That which is left, as in “residual urine” This can occur with inability to empty the bladder due to nerve damage; it increases the incidence of cystitis (bladder infection).
Retention Holding back…as in the inability to urinate or empty the bladder, requiring catheterization; one cause is involvement of damaged or irritated nerve pathways to the bladder.
Sacral Nerve Root Refers to the 5 pair of nerve roots which branch off of the sacrum. The spinal cord can be divided into segments according to the nerve roots that branch off of it. Nerves along the spinal cord consists of 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 1 coccygeal. The nerve roots run through the bony canal, and at each level a pair of nerve roots exit from the spine on the left and right side. These nerve roots are the most prevalent areas for the Tarlov cysts to form. The spinal canal extends into the sacrum and the sacral nerves exit the canal through bony foramina, ending in a bundle resembling a horse’s tail and called “Cauda equina”.
Sacrum The sacral spine or sacrum refers to the large irregular and inverted triangular shaped bone made up of the five fused vertebrae below the lumbar region.

Sciatica Low back pain and leg pain that usually travels along the path of the large sciatic nerve, from the lower back down the back of the leg. This pain can be felt when a nerve root in the lower spine that helps to form the sciatic nerve is pinched or irritated. One or more of the following sensations may occur as a result of sciatica:

· Pain in the buttock or leg that is worse when sitting

· Burning or tingling down the leg

· Weakness, numbness or difficulty moving the leg or foot

· A constant pain on one side of the buttock

· A shooting pain that makes it difficult to stand up

Scoliosis A curving of the spine in which the spine curves to the side and away from the midline.
SCS Spinal Cord Stimulator- In this therapy, electrical impulses are used to block pain from being perceived in the brain. Instead of pain, the patient feels a mild tingling sensation. A small wire (called a lead) connected to a power source is surgically implanted under the skin. Low-level electrical signals are then transmitted through the lead to the spinal cord or to specific nerves to block pain signals from reaching the brain. Using a magnetic remote control, you can turn the current on and off, or adjust the intensity. The sensations derived from the stimulator are different for everyone; however, most patients describe it as a pleasant tingling feeling.
Shingles An acute infection caused by the herpes zoster virus, which is the same virus that causes chickenpox. The virus remains dormant in nerve roots for many years following chickenpox, and can reactivate causing tremendous pain along the nerve roots, primarily those around the waistline and lower trunk of the body. Shingles are also referred to as post herpetic neuralgia (PHN).
Shunt A cerebrospinal fluid shunt is a system of valved tubes/catheters. It diverts cerebrospinal fluid from the subarachnoid space into another part of the body to drain it and prevent damage to the brain. In the case of Tarlov cysts, the shunt is to divert CSF away from the cyst and to prevent CSF pressure from increasing. The upper end of the shunt is placed in the subarachnoid space in the lumbar part of the spinal column; the lower end drains fluid into the peritoneum (the membrane that lines the walls of the abdominal cavity). This shunt is called a lumboperitoneal shunt.
Spina Bifida A congenital defect with failure of closure of one or more of the vertebral arches, which may be associated with malformations of the spinal cord, nerve roots, lipomas, and congenital cysts. These malformations range from mild to severe, including complete failure of neural tube and spinal cord fusion, resulting in exposure of the spinal cord at the surface of the skin. The open form is called “Spina Bifida Cystica” and the closed form is “Spinal Bifida Occulta”.
Spina Bifida Occulta The closed form of malformation of the spinal cord; a congenital defect of the neural tube due to failure of the vertebral arch to close
Spinal cord A large bundle of nerve fibers located in the back that extends from the base of the brain to the lower back, the spinal cord carries messages to and from the brain and the rest of the body.
Spinal nerves Any of the nerves that arise in pairs from the spinal cord. There are 31 pairs of spinal nerves in the human body.
Subarachnoid The space between the arachnoid and the pia mater (2 of the 3 meninges) covering the spinal cord
Symptomatic With symptoms or concerning symptoms that cause changes in body function or process
Symptomatology The combined symptoms of a disease
Syringomyelia Syringomyelia (sear-IN-go-my-EEL-ya) is a disorder by which a cyst forms within the spinal cord. This cyst, called a syrinx, expands and elongates over time, destroying the center of the spinal cord. Since the spinal cord connects the brain to nerves in the extremities, this damage results in pain, weakness, and stiffness in the back, shoulders, arms, or legs. Other symptoms may include headaches and a loss of the ability to feel extremes of hot or cold, especially in the hands. Each patient experiences a different combination of symptoms. Magnetic resonance imaging (MRI) has significantly increased the number of syringomyelia cases that are diagnosed in the beginning stages of the disorder. Signs of the disorder tend to develop slowly, although sudden onset may occur with coughing or straining. If not treated surgically, syringomyelia often leads to progressive weakness in the arms and legs, loss of hand sensation, and chronic, severe pain. In most cases, the disorder is related to a congenital abnormality of the brain called a Chiari I malformation. This malformation occurs during the development of the fetus and causes the lower part of the cerebellum to protrude from its normal location in the back of the head into the cervical or neck portion of the spinal canal. Syringomyelia may occur as a complication of trauma, meningitis, hemorrhage, a tumor, or arachnoiditis. Symptoms may appear months or even years after the initial injury, starting with pain, weakness, and sensory impairment originating at the site of trauma. Some cases of syringomyelia are familial, although this is rare.
Tarlov cyst Tarlov cysts are also known as perineural/perineurial, or sacral nerve root cysts. They are dilations of the nerve root sheaths and are abnormal sacs filled with cerebrospinal fluid that can cause a progressively painful radiculopathy (nerve pain). They are located most prevalently at the S2, S3 level of the sacrum and less commonly at S1. The sacrum is a fused triangle-shaped bone comprised of the 5 sacral vertebrae forming the base of the spine. The 5 lumbar vertebrae are located just above the sacrum, and the 4 coccygeal vertebrae are just below the sacrum forming the coccyx or tailbone.

The TCs appear on MRI to be dilated or ballooned areas of the sheaths that cover nerve roots exiting from the sacral region of the spinal column. The cysts are created by the dilated sheaths of the nerve roots directly connected to the subarachnoid area of the spinal column, through which the cerebrospinal fluid flows. Many people have TCs visible on a MRI, but have experienced no relevant symptoms. The cysts are perhaps identified, but are not acknowledged as significant by the radiologist reading the films or by the physician who ordered them. If the patient has no symptoms that might be suggestive of symptomatic TCs, and sometimes even if they do have symptoms, the patient might not be told about the finding on the MRI. It is not unusual if the cyst has been present for a number of years to see evidence of erosion and remodeling of the sacral bone. When conditions cause these cysts to fill with spinal fluid and to expand in size, they begin to compress important surrounding nerve fibers, or the cysts may contain nerve fibers, resulting in a variety of symptoms including chronic pain.

Below: 4 Intraoperative Tarlov cyst surgery slides

A: Intraoperative view of a large Tarlov cyst. B: Intraoperative view of the muscle flap, divided in the middle, used for the obliteration of the cystic space. C: Intraoperative view after cyst wall resection showing sacral spinalis muscle flap rotated into position in the presacral space to obliterate the cyst cavity. D: Photograph obtained immediately after closure, demonstrating a U-shaped incision over the lumbosacral area, with a lumbar subarachnoid drain placed for postoperative CSF diversion. To view the entire article click on this link


TC Tarlov cyst. This abbreviation is used by patients with Tarlov cysts, and is not a standardized medical abbreviation.
TENS Transcutaneous Electrical Nerve Stimulation- These devices deliver electrical impulses to the brain through the skin and nerves to control pain
Tethered cord Tethered spinal cord syndrome is a neurological disorder caused by tissue attachments that limit the movement of the spinal cord within the spinal column. These attachments cause an abnormal stretching of the spinal cord. The course of the disorder is progressive. Tethering may develop after spinal cord injury and scar tissue can block the flow of fluids around the spinal cord. Increased spinal fluid pressure may cause cysts to form in the spinal cord, a condition called syringomyelia. This can lead to additional loss of movement, feeling or the onset of pain or autonomic symptoms. In adults, surgery to free (detether) the spinal cord can reduce the size and further development of cysts in the cord and may restore some function or alleviate other symptoms.
Thecal sac A protective membrane that covers the spinal cord and cauda equina; it is a sac containing the spinal cord and spinal fluid.
Thoracic Pertaining to the chest area of the body. The thoracic region of the vertebral column consists of 12 vertebrae referred to as T1-T12. It is the longest section of the vertebral column and is between the cervical area above it and the lumbar area below it.
Trigger point An area in muscle or connective tissue that is hypersensitive to touch or pressure
Urodynamics Urodynamics refers to a group of procedures that are performed to examine voiding (urinating) disorders. Any procedure designed to provide information about a bladder problem can be called a urodynamic test. Most urodynamic testing focuses on the bladder’s ability to empty steadily and completely. It also can show whether or not the bladder is having abnormal contractions, which cause leakage. Your doctor will want to know whether you have difficulty starting a urine stream, how hard you have to strain to maintain it, whether the stream is interrupted, and whether any urine is left in your bladder when you are done. The urodynamic test is a precise measurement using sophisticated instruments.
UTI Urinary Tract Infection- It is a bacterial infection that affects any part of the urinary tract. Although urine contains a variety of fluids. salts, and waste products, it normally does not have bacteria in it. When bacteria get into the bladder and multiply in the urine, it causes a UTI. The most common type of UTI is a bladder infection, which is also often called cystitis. Cystitis means an inflammation of the bladder. UTIs are caused by bacteria, usually by the bacteria that are found in the intestines and sometimes on the skin around the rectal and vaginal areas. There are a number of symptoms associated with UTIs. Bladder infections are characterized by an urgent desire to empty the bladder. Symptoms include frequent urination, burning or pain during urination (dysuria), bladder spasms and the feeling of having to urinate even though little or no urine actually comes out. In some cases, you may have cloudy, bloody or foul-smelling urine, and maybe a mild fever. You should see your physician as soon as possible when you have these symptoms and the infection can be confirmed by urinalysis. Antibiotics will be given to kill the bacteria causing the infection. You should also increase your intake of water during the urinary infection. Patients with Tarlov cysts who have trouble emptying their bladder are more prone to frequent urinary tract infections.
Ventricles Small cavities of the brain where spinal fluid is produced
Vertebrae Vertebrae (singular: vertebra) are the individual irregular bones that make up the vertebral column (aka spine) — a flexuous and flexible column. There are normally thirty three (33) vertebrae in humans, including the 5 that are fused to form the sacrum (the others are separated by intervertebral discs) and the 4 coccygeal bones which form the tailbone. The upper three regions comprise the remaining 24, and are grouped under the names cervical (7 vertebrae), thoracic (12 vertebrae) and lumbar (5 vertebrae), according to the regions they occupy.