dr Zeegers: where is your pain coming from?
Often I am thinking of this very special patient, a 40-yr sports teacher, in The Netherlands a famous free fighter, who had a spinal lifting injury in 2001: immediately after that incident he got increasing restricting back pain: sharp pain and stabbing in his low back paravertebral right sided, immediately above his iliac crest, often radiating in his right buttock, always accompanied by varying cramps at the front of his right thigh. Quality scores (0=shit, 0=perfect): back 4/10 right leg 7/10, left leg li 10/10. Very increasing symptoms during exercise and is professional fighting. Very restricted in walking, because he had to stop and kneeling down every 500 meter. Sustained load almost impossible. Walking, standing and sitting only possible for short periods. The pain symptoms varying from intense to unbearable, with heavy restrictions in activities daily life (50% only). No mental problems. Validated Oswestry Disability Index 42/100%: moderate to severe impaired. Alternating use of painkillers every day. Father had two times a lumbar herniation and lumbar surgery. Muscular athletic posture, painful bending forward, stooping his hand 30 cm above the floor. But bending partially painful , only in second part was too painful to continue bending over, like a blockade, beyond that point that it was possible again, but restricted. Standing up from sitting difficult. Normal pulsations, Coming up painful too. Pain is not worse when bending, but there is as it were a block that is too painful to continue bending over. Beyond that it will succeed again.
Plain X Ray L Spine: DDD L4-5 disc disease with retro L4 L5. On the AP view L45 right narrower than the left. Suspicion on instability L4/L5. MRI L Spine: DDD L45, as well as black disc L34 L45, protrusion L4/L5, potentially compromising nerve root L5 right. Discography: positive memory pain L45, L34 atypical pain, L5S1 difficult to reach.
Treatment 2006: ADR L4L5 (Type Aesculaap – Active L spikes) Munich-Zeegers
Follow up: completely pain free.