Academic Center for Spinal Disorders (SPACE)

Life expectancy at age 60 will increase from 18.8 years in 2000 to 22.2 years in 2045. Hence, our health care systems will face increasing numbers of spinal disorders specific to the elderly and aging of the spine. As a result of medical comorbidities including spinal oncology, osteoporosis and severe spinal degeneration with scoliosis and the higher risk to fall due to a poor postural balance, the number of complex spinal pathologies will increase.

Recently it has been shown that low back and neck pain is one of the top five increasing causes of disability-adjusted life-years (DALYs) implying a major increasing global burden of disease. Our first aim is to improve outcome in all patients receiving (complex) spinal surgery in our institute and affiliated hospitals, including trauma, scoliosis, degenerative and oncological diseases.

Our multidisciplinary multicentered approach combined with clinical, epidemiological and translational research will help us to achieve our goals. Secondly we want to improve our world-leading role in epidemiological spine research and innovative spine and pain treatment. Next we want to improve education on spinal care on a national and international level and would love to have the first curriculum for a full spinal surgeon in The Netherlands.

Our objective is to maintain a healthy spinal life span and further develop our expertise in complex spinal care for today and the future. General practices are important in prevention and conservative treatment of spinal pathology. Like rehabilitation, the management of pain is indispensable in spinal care. The further development of surgical and anesthetic techniques for perioperative neuromonitoring in spine surgery will improve quality of life for our patients.

Academic Center of Excellence

Research Activities

Firstly, our ACE focuses on prevention, treatment and prognosis on low back and neck pain. Research projects include the MIN-T study: cost-effectiveness treatment low back pain(LPB), the BOZ study: effectiveness of minimal invasive treatment of LBP, the PACE plus trial: effects of paracetamol-diclofenac and advice, the BACE international cohort-study of LBP in the elderly, the PRINS study: a prevention study on LBP and neckpain and the I-Screen study: a project to reinstitute national screenings program for scoliosis.

Secondly, our ACE includes surgical intervention studies like the FIXET study comparing two scoliosis correction techniques, the Nucleoplasty trial comparing Open Anterior Cervical Discectomy and percutaneous cervical nucleoplasty and the PTED study comparing standard lumbar discectomy versus a novel technique, the Percutaneous Transforaminal Endoscopic Discectomy, which is an awake outpatient procedure. Next, we have started a basic and translational study for the Dorsal-Root-Ganglion stimulation and motor response. International collaboration exists with top institutes include the George-Institute, University of Sydney, Australia, Keele-University, UK, and the Cochrane Collaboration. International fellow program include students from e.g. Belgium, Ireland, UK, Germany and China. Finally research on Intra Operative Neuromonitoring (IONM) regarding the relationship of changes of IONM parameters and neurological outcome after spine surgery is underway.

Type of


International collaboration exists with top institutes include the George-Institute, University of Sydney, Australia, Keele-University, UK, and the Cochrane Collaboration. International fellow program include students from e.g. Belgium, Ireland, UK, Germany and China.



The ACE is involved in the education of BSc and MSc of Medicine, and is involved in creating the curriculum for Technical Medicine (Bos, Hulscher and Harhangi). Moreover the ACE is involved in training general practitioners, nurse training programs, the education of Physician Assistants, technicians, Residents, PhD's and surgical training programs on national and international level (PTED).

Innovation in spinal care is ongoing. Recently, the first national training program for endoscopic spinal surgery has been established and implemented and we are working on reproducible movement of lower extremities in spinal cord injury. In this bridging the spinal cord would be our ultimate goal.


Care Activities

The regional organization of spinal care provides a model to centralize low volume high complex disorders at our institute and perform all high volume low complex spinal care in our affiliated hospitals. Hence, most of our care is labeled as academic care according to the ROBIJN criteria and are treated multidisciplinary. Each year we perform 220-240 complex spine injuries, 90-100 scolioses surgery, 50-60 complex combined spine surgery, 40-50 intradural spinal pathology, X pain treatments (DRG, SCS).

In 2014 the analyses of 3046 patients treated within the scope of this ACE at our Hospital, showed that 72% met the ROBIJN criteria. With some more effort we will easily meet the 80% ROBIJN criteria, especially since almost all the neurosurgical procedures are 100% ROBIJN.

Epidemiological research mainly focuses on PROMS and preventive medicine to maintain a healthy spine as long as possible whereas clinical and translational research helps us to improve outcome in complex spinal care. All partners in this ACE have feedback programs including visitations and internal and external audit.

Societal Relevance to Research, Education and Patient Care

Several studies show that LBP is a leading cause of years lived with disability. The global burden of low back and neck pain is increasing within years and belongs to the world top 5. This will cause a huge socio-economic problem in the near future. By improving public education and healthy life style programs (physical activity, diet etc) the ACE will contribute to the maintenance of a healthy spine.

This ACE is involved in the development of guidelines for standardized spinal care. Development of a curriculum for the next generation spine surgeon is an important ambition of our ACE and innovation focuses on neuromodulation pain treatment and motor responses in spinal cord injury by bridging of brain to peripheral nerves. Innovative endoscopic spine surgery and IONM responds to needs of public health.

Viability of Research, Education and Patient Care

This viability of this ACE is inextricably linked to the aging spine. Effort is put on maintaining our current research programs and establishing novel research program. We have two research projects performed within a "Voorwaardelijke toelating traject reguliere zorg".

The results are used for decision making for reimbursement. Recently, two excellent medical students (Erasmus Honors project) have joined our ACE. Research project are broadened and international collaborations are being established (JST China, Kendal Lee Mayo Clinics, Pain Medicine with McGill University Montreal, a fellow program with the faculty of Pain medicine of anesthesists of Ireland, International Consortium CRPS,International collaboration with top institutes including the George-Institute, University of Sydney, Australia, Keele-University, UK, and the Cochrane Collaboration. International fellow program include students from e.g. Belgium, Ireland, UK, Germany and China. By improving our International collaboration and participation in international congresses we will attract name and fame, top research students and we will open treatment opportunities for foreign patients.

Key and relevant publications of the last five years

  • Enthoven WT, Roelofs PD, Deyo RA, van Tulder MW, Koes BW. Non-steroidal anti-inflammatory drugs for chronic low back pain. Cochrane Database Syst Rev. 2016 Feb 10;2:CD012087.
  • el Barzouhi A, Vleggeert-Lankamp CL, Lycklama à Nijeholt GJ, Van der Kallen BF, van den Hout WB, Jacobs WC, Koes BW, Peul WC; Leiden-The Hague Spine Intervention Prognostic Study Group. Magnetic resonance imaging in follow-up assessment of sciatica. N Engl J Med. 2013 Mar 14;368(11):999-1007.
  • Pinto RZ, Maher CG, Ferreira ML, Hancock M, Oliveira VC, McLachlan AJ, Koes B, Ferreira PH. Epidural corticosteroid injections in the management of sciatica: a systematic review and meta-analysis. Ann Intern Med. 2012 Dec 18;157(12):865-77.
  • de Rooij JD, Gadjradj PS, Huygen FJ, Luijsterburg PA, Harhangi BS, Management of Symptomatic Cervical Disk Herniation: a Survey among Dutch Neurosurgeons.. Spine (Phila Pa 1976). 2016 Jun 21. [Epub ahead of print]
  • Demographic and medical parameters in the development of complex regional pain syndrome type 1 (CRPS1): prospective study on 596 patients with a fracture. Beerthuizen A, et al. Pain. 2012 Jun;153(6):1187-92
  • A multicenter, prospective trial to assess the safety and performance of the spinal modulation dorsal root ganglion neurostimulator system in the treatment of chronic pain Liem L. et al. Neuromodulation 16,5 471-482
  • Clinical outcomes after percutaneous transforaminal endoscopic discectomy for lumbar disc herniation: a prospective case series. Gadjradj PS, van Tulder MW, Dirven CM, Peul WC, Harhangi BS. Neurosurg Focus. 2016 Feb;40(2):
  • Back schools for acute and subacute non-specific low-back pain. Poquet N, Lin CW, Heymans MW, van Tulder MW, Esmail R, Koes BW, Maher CG. Cochrane Database Syst Rev. 2016 Apr 26;4
  • Prevalence of spinal pathology in patients presenting for lumbar MRI as referred from general Schepper EI, Koes BW, Veldhuizen EF, Oei EH, Bierma-Zeinstra SM, Luijsterburg PA. Fam Pract. 2016 Feb;33(1):51-6
  • Effectiveness of surgery for lumbar spinal stenosis: a systematic review and meta-analysis. Machado GC, Ferreira PH, Harris IA, Pinheiro MB, Koes BW, van Tulder M, Rzewuska M, Maher CG, Ferreira ML. PLoS One. 2015 Mar 30;10(3)

PhD theses of the last five years

  • M. Dirckx CRPS, an inflammatory disease
  • M. Dirckx CRPS, an inflammatory disease
  • Enthoven W. Back pain in older adults: subgroups and health care utilization (2016)
  • Verkerk K. Chronic non-specific low back pain. Course and prognosis (2014)
  • Scheele J. Back complaints in older adults (2013)
  • Schellingerhout J. Neck pain in primary care: prognosis and methodology (2011)
  • Maas E. Costeffectiveness of radiofrequency for chronic lowbackpain 2016
  • Verwoerd A. ‘Diagnosis and prognosis of Sciatica’ 2015

Non-scientific publications related to the ACE

Collaborating investigator(s)

Last updated: 365 days ago.