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.

Disc

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 "annular fibrosus". The nucleus puplosus 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 chronic back pain and can be treated best with Deuk Laser Disc Repair.

Facet Joint Capsule

Connective tissue membrane wrapping around the facet joint stabilizing the movement of the bones and bolding the synovial fluid lubricating the facet joint. Damage to the facet capsule allows excessive movement of the facet join t leading to spinal instability and pain. Trauma, such as moto vehicle accidents or falls, is the leading cause of facet joint capsule infury. Surgical trauma during invasive spine surgery (laminectomy, microdiscectomy, MILD procedure, artificial disc and fusion) si 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 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.

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, microdisecectomy, discectomy, MILD procedure, interspinous devices. Deuk Laser Deisc Repair does not damage the ligamentum flavum.

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.

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 love of the brain. Discogenic pain is only possible because of this nerve carrying pain signals to out consciousness.

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.

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.

Myelopath is spinal cord dysfunction and may manifest as balance difficulty, decreased coordination of the urinary urgence. The spinal cord gives off verve roots that control movement and feeling in the legs.

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.