Nomenclature and Terminology for Spine Specialists (Appropriate words meant to replace the most commonly misused words of the spine specialists)

Spine Nomenclature

Spine textbooks, scientific journals, and anatomical texts are fraught with inaccuracies of nomenclature and terminology regarding the spine. Subsequently, teaching at all levels, including; residency and spine fellowship programs, is adversely affected. These perpetuated inaccuracies diminish our ability to accurately interpret and apply scientific research findings to a physician’s clinical or academic practice.

Utilizing precise anatomical nomenclature forces a higher standard and provides physicians with an enhanced ability to understand associated procedural terminology.  This serves to hasten abandonment of inappropriate terminology.

Commonly Misused Words
Interlaminar space correctly replaces translaminar space. Interlaminar defines the space separating the lamina of adjacent segments. An injection accessing the epidural space through this region is an interlaminar epidural injection and not a translaminar epidural injection.

Intervertebral foramen correctly defines the space through which the exiting spinal nerve traverses. It is prefixed by its two adjacent segments (i.e., L5-S1 intervertebral Foramen). It is incorrect to call this foramen either the “neuroforamen” or the “intravertebral foramen.”

Vertebral foramen is the large axially oriented opening containing the spinal cord and thecal sac. The vertebral foramina of the vertebrae are aligned to form the vertebral canal. It is often mislabeled as the “central canal.”

The spinal nerve, neither the “nerve root” nor the “spinal nerve root”, exits through the intervertebral foramen. For this reason one never performs a “nerve root block.”  Immediately after the spinal nerve exits the intervertebral foramen, it divides into its posterior and anterior ramus.

Zygapophysial joint is the correct name to replace “facet joint”. Facet is incorrect because that word represents the articular cartilage surface lining numerous small joints of the body including the phalanges, costotransverse and costovertebral joints. The word is commonly misspelled “zygapophyseal.” The joint is correctly abbreviated “z-joint.”

Vertebral endplates are not the bony superior and inferior aspects of vertebral bodies as is often erroneously suggested on x-ray reports. Plain film radiographs cannot discern endplate compression fractures. Those regions are correctly termed the “ring apophysis” The ring apophysis is bone and the vertebral endplates are the terminal fibrocartilage portions of the intervertebral disc.

Transitional Segment is ambiguous and should thus be avoided. Instead, precise definition requires using sacralized L5 segment or lumbarized S1 segment. If these or other aberrances, including extra or missing ribs, cause one to be uncertain of the level of an exiting spinal nerve, remember the following rule: The spinal nerve exiting through the intervertebral foramen 25 segments caudal to the foramen magnum is the 5^th lumbar spinal nerve. Although this technique is often not readily applicable, it serves as an occasional necessary tool.

 The medial branch of the dorsal ramus (or posterior primary ramus) innervates the zygapophysial joint capsule. Two medial branches always innervate each capsule. It is not the “median” branch. Additionally, it is not a nerve; instead, it is a “branch” of a nerve. The term paramedian nerve is a misnomer. A “paramedian block” serves no validated purpose.

Atlanto-occipital and Atlanto-axial joints are not zygapophysial joints, owing to their anterior location. By definition, z-joints are posterior elements. “occipito-atlantal” is incorrect.

Spine Procedural Terminology

Epidural injections are not “blocks”. The word "block" should only be utilized when one specifically places local anesthetic onto a nerve or nerve branch for the sole purpose of stopping transmission of sensation or motor function (i.e., medial branch block) 

Interlaminar epidural injection – Not translaminar

Transforaminal injection – Not nerve root block. Not selective nerve root block. Not selective epidural. Not transforaminal selective epidural.

Spinal nerve block – Not root block. Not spinal nerve root block.

Ventral ramus block – Targeted more distally and anteriorly to avoid blocking innervation of the posterior elements

Zygapophysial joint intra-articular injection – Not facet block

Medial branch neurotomy – Not “rhizotomy” which refers to cutting a “root”

Lesion- Recently added to Webster’s Dictionary through our specialties’ lobbying efforts. It now refers to both a verb (to cut) and its previous noun form.

L5 dorsal ramus neurotomy – Not L5 medial branch neurotomy
 

Sacroiliac joint intra-articular injection – Not SIJ block 

Medial branch and L5 dorsal ramus block – Not paramedian nerve block (remember: only two medial branches per joint)

Provocation discography –  Not provocative discography

IDEA (intradiscal electrothermal annuloplasty) is a “generic” term for the trademarked name

IDET (intradiscal electrothermal therapy)

Disc biologic – One of the newer therapeutics which causes the repair of tears and fissures within the anulus fibrosis and alters the chemical milieu of the intervertebral disc. 

These suggestions may appear trivial, however your incessant application of these terms is necessary to "raise the standard" of our field.

Kevin J. Pauza, MD, Chair, PASSOR Educational Guidelines Task Force

Updated 2005