Nijmegen Decision Tool / Live Surgery

To refer to Surgeon

Or Not

To refer to Surgeon

RJ Kroeze

1

Patient J. ♀ 57 yr

Persistent low-back pain after right-side decompression l4-l5-S1

(2016-2)

Past medical history

• Depression

• ILD L4-L5 w herniotomy (HNP) & ILD L5-S1 (HNP)

• A1 # L3 (2012)

Medication

• Fluvoxamine

• Various pain meds

Allergies

• none

2

History of present illness

Leg pain resolved after ILD, low-back pain continued, possibly

progressive

Axial rotation and static composure (sitting/standing) increase pain,

walking slightly better (10 mins)

Nightpain during movement:+

Bowel/bladder function: normal

Sensomotor deficit legs: none

FT: no effect

Spinal orthosis: some effect

3

Examination

L 170 cm W 70 kg

Mild antalgic gait

Leg length discrepancy: none

Painfully decreased ROM lumbar spine, esp. extension painfull

Hips/knees: painless FROM

Neurological examination:

Motor function: no deficits

Sensory function: no deficits

Reflexes: brisk

4

Spine registration form

NRS: back-pain:6

(0-10) leg-pain:0

ODI: 47

(0-100)

EQ-5D: 0,128

(0-1)

5

Diagnostic tests

Radiography

MRI

Discography

6

Radiography

7

MRI pre-ILD

8

IVD L4-L5

MRI post-ILD

9

IVD L4-L5

MRI II

10

Discography

11

Recognizable pain during contrast injection / provocation

Direct relief of all pain after bupivacaine injection

Nijmegen Decision Tool

12

Nijmegen Decision Tool

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Nijmegen Decision Tool

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Conclusion

persistent mechanical low-back pain following succesfull right-sided ILD

L4-L5-S1, with modic type 1 DDD and positive reaction to discoblock

L4-L5.

15

Treatment

ALIF L4-L5 w instrumentation (TLS)

16

Dr v Loon Dr Spruit

Live Surgery

17