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Spacer located between two adjacent vertebral bodies. The disc has a soft, compressible core called the “nucleus pulposus” surrounded by a firm, elastic outer ring-like wall called the “annulus fibrosus”. The nucleus pulposus is normally an avascular, water-rich compressible semi-solid (think raw shrimp meat) that acts as hydraulic fluid distributing spinal compression forces outward towards the annulus fibrosus. In an injured disc, the herniated nucleus pulposus causes a severe inflammatory response within the outer annulus fibrosus. Herniated discs are the most common cause of neck pain and can be treated best with Deuk Laser Disc Repair.
Spinal Cord
Large bundle of nerves connecting the brain with the rest of the body outside the skull. The spinal cord may become damaged by herniated discs in the cervical spine.
Myelopathy is spinal cord dysfunction and may manifest as balance difficulty, decreased coordination of the hands or urinary urgence. The spinal cord gives off nerve roots that control movement and feeling.
Vertebral Artery
Paired arteries located in the neck. These arteries supply 20% of the brain’s total blood supply. The arteries run in the foramen transversarium of cervical vertebrae.
Annulus Fibrosus (AF)
Outer ring of dense, circular connective tissue making up the spinal disc. The annulus fibrosus is composed of 20 concentric layers of collagen fibers wrapped around a soft core, the nucleus pulposus. It is important to note the inner half of annulus fibrosus is normally without blood vessels or nerves. On the other hand, the outer half of annulus fibrosus has blood vessels capable of inflammation and innervation from the Sinuvertebral nerve capable of transmitting pain.
The most common cause of neck pain is an inflamed posterior annular tear of the spinal disc. This occurs when a traumatic injury tears the back wall of the disc (posterior annular tear) thus allowing pieces of nucleus pulposus to escape (herniate) into the tear and cause inflammation within the tear. Inflammation within an injured disc’s posterior annular tear is the most common source of neck pain worldwide. The best treatment is Deuk Laser Disc Repair.
Facet Joint Capsule
Connective tissue membrane wrapping around the facet joint stabilizing the movement of the bones and holding the synovial fluid lubricating the facet joint. Damage to the facet joint capsule allows excessive movement of the facet joint leading to spinal instability and pain. Trauma, such as motor vehicle accidents or falls, is the leading cause of facet joint
capsule injury. Surgical trauma during invasive spine surgery (laminectomy, microdiscectomy, MILD procedure, artificial disc and fusion) is another leading cause. Deuk Laser Disc Repair does not damage the facet joint capsule.
The sensory nerve to the facet joint capsule is the medial branch of the dorsal ramus. This nerve contains somatic afferent sensory fibers that transmit pain signals to the primary somatosensory cortex of the brain allowing conscious localization of the painful facet joint(s). The best treatment for facet joint pain or facet capsule pain is Deuk Plasma Rhizotomy of the painful facet joint(s).
Facet Joint
Paired diarthrodial, segmental spinal joints that stabilize the spine’s movement when twisting and bending. Each spinal segment has a pair of facet joints located immediately behind the disc on the right and left sides of the spine. Injury to the facet joints causes inflammation and pain. Trauma, such as motor vehicle accidents, falls and sports injuries, is the leading cause of facet joint injury. Surgical trauma during invasive spine surgery (laminectomy, microdiscectomy, MILD procedure, artificial disc and fusion) is another leading cause of facet joint injury. Deuk Laser Disc Repair does not damage the facet joint or any other spine structure.
Lamina
A normal vertebral flat bony plate-like projection in the back of the spine where
paraspinal muscles attach for postural movement and ligaments attach to stabilize the spine. This bone and its ligaments (ligamentum flavum, foraminal ligament and facet joint capsule) are damaged or removed during commonly performed open spine surgeries such as laminectomy, laminoplasty, interspinous devices, discectomy, microdiscectomy, fusion and foraminotomy. Deuk Laser Disc Repair does not damage the lamina or any other normal spine structures.
Ligamentum Flavum
Thick plate of connective tissue ligaments within the posterior spinal canal, attaching adjacent lamina bones. These ligaments stabilize the spine from excessive movement. Injury to the ligamentum flavum causes spinal instability and pain. Ligamentum flavum is either damaged or removed during invasive spine surgery. The most common spine surgeries that damage or remove the ligamentum flavum include laminectomy, microdiscectomy, discectomy, MILD procedure, interspinous devices. Deuk Laser Disc Repair does not damage the ligamentum flavum.
Medial branch of the dorsal ramus
The normal sensory nerve to the facet joint and facet joint capsule. When the facet joint or capsule is damaged, the body tries to heal the injury with inflammation. Inflammation is painful and the medial branch of the dorsal ramus sends pain signals from the injured facet joint and capsule up to the brain for processing. The signals are interpreted by the consciousness as neck pain (cervical facet joint injuries). The medial branch of the dorsal ramus is the “pain nerve” responsible for transmitting the pain signals we feel.
This “pain nerve” is the target of pain management procedures including Radio Frequency Ablation (RFA) and Medial Branch Block (MBB). RFA and MBB may at best provide temporary relief of facet joint-capsule pain. Deuk Spine Institute founder, Dr. Ara Deukmedjian MD, developed and patented the Deuk Plasma Rhizotomy, a procedure performed first at Deuk Spine Institute in 2022. Deuk Plasma Rhizotomy is the first permanent treatment for facet joint pain in the cervical, thoracic, lumbar spine and sacroiliac joint. Deuk Plasma Rhizotomy allows the surgeon to permanently decommission the medial branch of the dorsal ramus thus effectively eliminating facet joint pain in the treated parts of the spine. Deuk Plasma Rhizotomy is now also used to treat knee, shoulder and hip pain.
Nerve Root
A bundle of nerve fibers responsible for transmitting motor and sensory data between the brain and extremities. Connects brain & spinal cord to muscles for movement and sensors located in skin, joints and muscles. Nerve roots pass behind the spinal discs through natural openings in the spine called neuroforamen. Disc herniations can easily irritate or pinch nerve roots within the neuroforamen. Spinal stenosis typically affects nerve roots with pressure causing arm weakness, numbness, or tingling (radiculopathy). Inflammation of the nerve root typically causes arm pain (neck). Symptoms from inflammation of the nerve root are called radiculitis. Contrary to popular belief, nerve root compression or irritation never cause neck pain.
Neuroforamen
Paired, round, natural openings on the sides of the spinal canal where nerve roots pass in and out of the spine on their way from the spinal cord to target muscles, skin, joints and viscera. Also known as the intervertebral foramen, the neuroforamen are located immediately behind the spinal discs, in front of the facet joints and between the bony pedicles. Damage to the disc or facet joint may result in foraminal narrowing called “neuroforaminal stenosis”. Nerve roots are very sensitive to the effects of neuroforaminal stenosis which leads to
radiculopathy or nerve root dysfunction. The most common form of spinal stenosis is neuroforaminal stenosis and the most common cause of neuroforaminal stenosis is a herniated disc. The best treatment for neuroforaminal stenosis or a herniated disc is Deuk Laser Disc Repair.
Nucleus Pulposus (NP)
Centrally located hydraulic soft tissue contained within the middle of the spinal disc, embryologically derived from the notochord. The annulus fibrosus forms a circular wall around the nucleus pulposus to hold it in place during normal activities like bending and twisting. The nucleus pulposus is biomechanical “cushion” that, under loading forces, absorbs and redistributes mechanical forces evenly to the inner annulus fibrosus wall. When overloaded, a traumatic annular wall tear is the most common type of disc injury. The annular tear results from excessive force applied to the spine causing a failure of the disc.
Once an annular tear occurs there is now a pathway for pieces of nucleus pulposus to escape the disc and herniate out through the tear in the annular wall. Herniation is the movement of the nucleus pulposus into the annular tear and sometimes out the other side. There are many names given to a herniated disc but they are all part of the same condition at different stages. Small herniations are called disc bulges or protrusions. Larger herniations are called prolapsed, slipped, extruded, migrated and even sequestered discs. The herniated nucleus pulposus can cause inflammation and pain within the annular tear. Bulging discs are the most common cause of neck pain. The best treatment is Deuk Laser Disc Repair.
Sinuvertebral Nerve
Sensory nerve to the back of the disc (posterior annulus fibrosus) and posterior longitudinal ligament. Somatic afferent nerve fibers transmit painful stimuli from the posterior annulus fibrosus through the dorsal root ganglion via neural pathways to the primary somatosensory cortex in the parietal lobe of the brain. Discogenic pain is only possible because of this nerve carrying pain signals to our consciousness.
Spinal Canal
The space in the center of the spine surrounded by vertebrae and joints called discs and facet joints, where the spinal cord and nerve roots pass through protected as they course from the brain to their target locations. Located behind the vertebral body and discs, in front of the lamina and ligaments, the spinal canal is filled with spinal fluid bathing delicate neural structures. Narrowing of the spinal canal is called central stenosis. The most common cause of spinal canal stenosis is a disc injury called herniated disc. The best treatment for spinal stenosis or a herniated disc is Deuk Laser Disc Repair.
Spinous Process
A normal vertebral bony projection in the back of the spine where paraspinal muscles attach for postural movement and ligaments attach to stabilize the spine. This bone and its ligaments (supraspinous and interspinous ligaments) are damaged or removed during commonly performed invasive spine surgeries such as laminectomy, laminoplasty, interspinous devices, discectomy, microdiscectomy, fusion and foraminotomy. Deuk Laser Disc Repair does not damage the spinous process or any other normal spine structures.
Transverse Process
A normal vertebral bony projection on the side of the spine where paraspinal muscles or ribs attach allowing postural movement.
Vertebral Body
Large weight bearing rectangular bone located in the front of the spine between spinal discs. May fracture with osteoporosis or spinal trauma.
Annulus Fibrosus (AF)
Outer ring of dense, circular connective tissue making up the spinal disc. The AF is composed of 20 layers of concentric collagen fibers wrapped around a soft nucleus pulposus core. Inner half of AF is normally without blood vessels or nerves. Outer half of AF has blood vessels and pain nerves. Inflammation of a spinal disc occurs when the AF is torn by trauma (annular tear) and nucleus pulposus fragments herniate (extrude) into the annular tear with normal physiological loading of the disc. Inflammation within an injured disc’s posterior annular tear is the most common source of back pain or neck pain worldwide. The best treatment is Deuk Laser Disc Repair.
Facet Joint
Paired diarthrodial, segmental spinal joints that stabilize the spine’s movement with twisting and bending. Each spinal disc has a pair of facet joints located immediately behind the disc on the right and left. Injury to facet joints with resulting inflammation of the joint is the second most common cause of back pain or neck pain and stiffness. These joints are injured with trauma to the spine and during commonly performed open spine surgeries like laminectomy, discectomy, microdiscectomy, fusion and foraminotomy. Deuk Laser Disc Repair does not damage these structures.
Lamina
A normal vertebral flat bony plate-like projection in the back of the spine where paraspinal muscles attach for postural movement and ligaments attach to stabilize the spine. This bone and its ligaments (ligamentum flavum, foraminal ligament and facet joint capsule) are damaged or removed during commonly performed open spine surgeries like laminectomy, laminoplasty, interspinous devices, discectomy, microdiscectomy, fusion and foraminotomy. Deuk Laser Disc Repair does not damage these structures.
Medial branch of the dorsal ramus
The normal sensory nerve to the facet joint that transmits pain signals from the injured facet joint to the brain. The signals are interpreted as back pain or neck pain depending on which facet joint(s) are the source of pain. This “pain nerve” is the target of the patented Deuk Plasma Rhizotomy procedure first performed at Deuk Spine Institute in 2022 providing the first permanent treatment for facet joint pain in the cervical, thoracic, lumbar, and sacral spine.
Nerve Root
A bundle of nerve fibers responsible for transmitting motor and sensory data between the brain and extremities. Connects brain & spinal cord to muscles for movement and sensors located in skin, joints and muscles. Nerve roots pass behind the spinal discs through natural openings in the spine called neuroforamen. Disc herniations can easily irritate or pinch nerve roots within the neuroforamen. Spinal stenosis typically affects nerve roots with pressure causing arm or leg weakness, numbness, or tingling (radiculopathy). Inflammation of the nerve root typically causes arm pain or leg pain (radiculitis). Nerve root compression or irritation never causes back pain or neck pain.
Neuroforamen
Natural paired, round openings on the sides of the spinal canal where nerve roots pass in and out of the spine on their way to target tissues. Located behind the spinal disc and in front of the facet joints, damage to either structure could result in neuroforaminal stenosis (narrowing) affecting the nearby nerve root. The most common form of spinal stenosis is neuroforaminal stenosis and the most common cause of neuroforaminal stenosis is a herniated disc. The best treatment for a herniated disc is Deuk Laser Disc Repair.
Nucleus Pulposus (NP)
Centrally located hydraulic soft tissue contained in the middle of the spinal disc, embryologically derived from notochord. The annulus fibrosus forms a circular wall around the nucleus pulposus to hold it in place during normal loading activities like bending and twisting. The NP purpose is biomechanical: to absorb and redistribute mechanical forces evenly to the inner annulus fibrosus wall. Annular wall tear is the most common type of disc injury that results from excessive force trauma to the spine. Once an annular tear forms, a NP fragment can easily escape through the annular tear and either get stuck inside the annular tear (called extruded, prolapsed, contained, interposed herniation or bulging disc) or the NP fragment can go completely beyond and outside the annular tear (protruded, ruptured, or sequestered herniation). Bulging (herniated) discs are the most common cause of back pain or neck pain. The best treatment is Deuk Laser Disc Repair.
Spinal Canal
The space in the center of the spine where the spinal cord and nerve roots pass through protected from outside forces as they course to their target locations. Located behind the vertebral body and discs, in front of the lamina and ligaments, the spinal canal is filled with spinal fluid bathing delicate neural structures. Narrowing of the spinal canal is called central stenosis.
Spinous Process
A normal vertebral bony projection in the back of the spine where paraspinal muscles attach for postural movement and ligaments attach to stabilize the spine. This bone and its ligaments (supraspinous and interspinous ligaments) are damaged or removed during commonly performed open spine surgeries like laminectomy, laminoplasty, interspinous devices, discectomy, microdiscectomy, fusion and foraminotomy. Deuk Laser Disc Repair does not damage these structures.
Transverse Process
A normal vertebral bony projection on the side of the spine where paraspinal muscles or ribs attach allowing postural movement.
Vertebral Body
Large weight bearing rectangular bone located in the front of the spine between spinal discs. May fracture with osteoporosis or spinal trauma.