Dr W Adriaan Liebenberg is the founder of The Health Collective (Pty) Ltd, a healthcare organisation focused on transforming access to chronic pain management, primary care, and preventive medicine in South Africa. With more than two decades of experience in medicine, he is recognised for developing evidence-based models of care that combine clinical excellence, patient-centred outcomes, and healthcare sustainability.
After obtaining a Master of Neurosurgery from Stellenbosch University and qualifying as a Fellow of the College of Neurosurgeons of South Africa, Dr Liebenberg completed a clinical fellowship at Brighton and Sussex University Hospitals NHS Trust in the United Kingdom. Following his return to South Africa, he established successful neurosurgical practices in Paarl, Bellville, and Kingsbury Hospital.
Over time, his focus shifted from treating structural disease through surgery to addressing the broader challenge of chronic pain. This led him to co-establish The Pain Collective, one of South Africa's largest networks of chronic pain clinics, and to dedicate his work to pain medicine, interdisciplinary care, patient education, and healthcare system innovation.
Building Better Systems of Care
Dr Liebenberg's work now focuses on the design of healthcare systems that improve patient outcomes while ensuring the responsible and sustainable use of healthcare resources. His interests include chronic pain management, interventional pain medicine, healthcare governance, clinical pathway design, and the development of outcome-driven models of care.
Through The Health Collective, he has helped establish a number of healthcare initiatives, including:
The Pain Collective – a national network of chronic pain clinics providing interdisciplinary assessment and management of complex pain conditions.
Better Health Family Collective – an integrated primary care model focused on family medicine, prevention, and long-term health outcomes.
Pain Collective Community – a non-profit initiative working to improve access to pain care in underserved communities.
Three Sages Functional Café Bars – a health and nutrition initiative exploring innovative ways to promote wellbeing, healthy lifestyle choices, and preventative healthcare within communities.
His current work includes the development of governed care pathways, healthcare technology platforms, clinical registries, and outcome-measurement systems designed to align the interests of patients, healthcare practitioners, and healthcare funders.
He regularly collaborates with clinicians, healthcare organisations, academic institutions, and industry partners on projects related to chronic pain, healthcare innovation, and system redesign.
QUALIFICATIONS & PUBLICATIONS
Qualifications:
MMed Neurosurgery (Stellenbosch), Dec 2004
Fellow of the College of Neurosurgeons (S.A), March 2003
Registrations:
Health Professions Council of South Africa (MP 0436607)
Medical Protection Society (01/32266)
Memberships:
PainSA - painsa.org.za
IASP – International Association for the Study of Pain
SASS – South African Spine Society
Representative positions:
Council Member - PainSA
CONDITIONS THAT CAUSE PAIN
TESTS
MRI scan
What is an MRI (magnetic resonance imaging) scan?
This scan is performed with magnetism. A very large magnet aligns and realigns the molecules of the body and a computer then interprets the signals that are received and turns them into images. These images are really very clear and all the tissues in the body can be seen in great detail. As with CT scans, contrast can be used to give greater detail to blood vessels and also to indicate inflammation and cancer.
Read MoreCT scan
What is a CT scan (CAT scan)?
Computed tomography or CT scans have been with us for many years and are performed for many different disease entities. A CT scan is made up of ordinary X-rays (tomograms) that are fed into a computer (computed). They can be performed with a contrast medium (dye) that is injected into the patient’s veins. This contrast medium is usually iodine-based and circulates in the vascular system of the body.
Read MoreMyelogram
What is a myelogram?
This test is performed with a contrast agent that is injected into the spinal canal with a technique called a lumbar puncture. The patient is placed on a table that can tilt and is tilted so that the contrast medium can run up and down the spinal canal. A CT scan of the spine is performed at the same time and images are then generated that can indicate whether there is an obstruction of the nerves of the spine.
Read MoreDiscogram
What is a discogram?
In this test, contrast is injected with the help of fluoroscopy directly into the intervertebral disc. The test has two elements. The first element is when your doctor tries to mimic your pain by injecting fluid into your disc and therefore tries to place stress on the disc.
Read MoreEMG
What is an electromyogram (EMG)?
This is a test of the electric conductivity of the nerves of the body. This can be done by measuring the transit time in nerves and measuring the response in the muscles that are supplied by these nerves. The measuring instrument is a small needle that is placed in the muscle and then connected to a machine that measures very small electric impulses.
Read MoreTERMINOLOGY FOR CT AND MRI SCANS
Spinal stenosis and cervical spondylosis – This means that the spinal canal is narrowed. This is usually because the joints that are between the vertebrae, called the facet joints, have hypertrophied (become larger) secondarily to osteoarthritis of these joints. At the same time the ligament that runs inside the spinal canal, the ligamentum flavum, has also hypertrophied and is pushing on the nerves. The third component that causes spinal stenosis is the pressure from degenerative discs that push into the spinal canal.
Facet joint hypertrophy – This is when the joints between the vertebrae become large and irregular. This is because the joints are damaged by arthritis (osteoarthritis).
Annular tear – This describes the condition where the intervertebral disc has early damage. The damage comprises of a tear in the annulus fibrosus (see the section Anatomy of the Spine). The tear causes different inflammatory substances to be released by the body and this can cause local neck pain, referred pain and even radiculopathy (see the section Cervical Slipped Disc).
ANATOMY OF THE SPINE
The spine consists of vertebrae (bones) that encircle and protect the spinal cord. These vertebrae are responsible for allowing the spine to move while protecting the spinal cord. To allow for movement and stability, the vertebrae interlock with one another with a joint on either side, one on the left and one on the right. The vertebrae are also separated from one another by intervertebral discs.
The discs are made of a type of cartilage. The disc is made up of a soft, gel-like centre, called the nucleus pulposus, and this gel is kept in position by a tough outer fibrous layer called the annulus fibrosus.
YOU AND YOUR SPINE
TREATMENTS
TREATING BACK PAIN
Back Care
People who have spinal problems have them because of a genetic tendency or susceptibility they have towards spinal disease. The spinal column is one organ and people who have lower back problems frequently will develop, or at the same time have neck problems. Spinal surgery should be reserved for nerve compression and intractable pain that impairs a patients everyday life and functionality substantially. Spinal surgery changes the biomechanics of the spine and frequently leads to further spinal surgery. The mainstay in the treatment of back pain therefore is prevention. This chapter aims to explain how to go about putting as little strain on your spine as possible.
Read MoreTREATING HEADACHES
Headache Care
People who have spinal problems have them because of a genetic tendency or susceptibility they have towards spinal disease. The spinal column is one organ and people who have lower back problems frequently will develop, or at the same time have neck problems. Spinal surgery should be reserved for nerve compression and intractable pain that impairs a patients everyday life and functionality substantially. Spinal surgery changes the biomechanics of the spine and frequently leads to further spinal surgery.
Read MoreTREATING PELVIC PAIN
Pelvic Care
People who have spinal problems have them because of a genetic tendency or susceptibility they have towards spinal disease. The spinal column is one organ and people who have lower back problems frequently will develop, or at the same time have neck problems. Spinal surgery should be reserved for nerve compression and intractable pain that impairs a patients everyday life and functionality substantially. Spinal surgery changes the biomechanics of the spine and frequently leads to further spinal surgery.
Read MoreTREATING FACIAL PAIN
Facial Care
People who have spinal problems have them because of a genetic tendency or susceptibility they have towards spinal disease. The spinal column is one organ and people who have lower back problems frequently will develop, or at the same time have neck problems. Spinal surgery should be reserved for nerve compression and intractable pain that impairs a patients everyday life and functionality substantially. Spinal surgery changes the biomechanics of the spine and frequently leads to further spinal surgery.
Read MoreMINIMALLY INVASIVE TREATMENT
CAUDAL BLOCK
(This is the section that explains the detail of the operation or procedure above and should be read in conjunction with the section Your Back Operation). A caudal/sacral block is performed for pain that is caused by inflammation and irritation in the spinal canal. The aim of the procedure is to reduce the inflammation inside the spinal canal. This will then bring about partial or complete (but usually temporary) relief of the pain, spasm and referred pain that this inflammation around the nerves can cause.
LUMBAR NERVE ROOT BLOCK
(This is the section that explains the detail of the operation or procedure above and should be read in conjunction with the the section Your Back Operation). A lumbar nerve root block is performed for pain that is caused by an irritated nerve root. The aim of the procedure is to reduce the inflammation of the nerve root and also to block the pain impulse from travelling up the nerve to the brain. This will then bring partial or complete (but usually temporary) relief of the pain.
LUMBAR RADIOFREQUENCY NEUROMODULATION (RFR)
A lumbar RFR procedure is performed for pain that is caused by damaged facet joints. The aim of the operation is to temporarily paralyse the very small nerves that supply the facet joint of pain sensation. This will then bring partial or complete (but usually temporary) relief of the pain, spasm and referred pain that these damaged facet joints can cause.
INVASIVE THERAPY - SURGERY
A lumbar microdiscectomy is performed for a slipped (herniated or prolapsed) disc. The aim of the operation is to remove the bit of the nucleus pulposus (see the sections Your Back Operation and Anatomy of the Spine) that has herniated through the annulus fibrosus. It is important to realise that the remainder of the nucleus pulposus will remain behind and can eventually also herniate and cause repeated symptoms.
READ MOREA lumbar decompression is performed for trapped nerves. The aim of the operation is to remove the compressive elements that are compressing the nerves of the spine. This may be caused by bone, ligaments or even parts of discs.
READ MOREBACK EXERCISES AFTER INTERVENTION
Before you start with these exercises, let the physiotherapist go through them with you to make sure that you do them correctly. Then the therapist can adapt them if necessary.
Your exercises must be done 2-3 times a day. Stretches and exercises must not cause any pain. If any of the exercises or stretches cause any pain, reduce the intensity. If it still continues to cause pain, stop immediately and contact your therapist.
THE HOSPITAL
GOING TO THEATRE
The sterile environment of a theatre complex, out of necessity, is not a welcoming and warm place. For your safety the walls are bare and unnecessary furniture is not allowed beyond what is needed to perform the procedure. Operating theatre equipment is designed with functionality in mind and is not known for their aesthetic qualities.
Specialists dressed in sterile clothes appear drab and wear caps to keep hair covered and face masks, which often make them appear unfriendly and forbidding. Specialists and theatre staff are, however, used to these surroundings and to them it is a welcoming, well-known area in which they make their daily living and they see past the drab surrounds.
ANAESTHESIA
Before you come into hospital
Here are some things that you can do to prepare yourself and reduce the likelihood of difficulties with the anaesthetic. If you have asthma, emphysema, any heart condition or other chronic disease, you will be evaluated by an anaesthetist or specialist prior to surgery.
If you have loose or broken teeth, or crowns that are not secure, you may want to visit your dentist for treatment. The anaesthetist may need to put a tube in your throat to help you breathe, and if your teeth are not secure, they may be damaged.
TREATING NECK PAIN - MINIMALLY INVASIVE TREATMENT
A cervical nerve root block is performed for pain that is caused by an irritated nerve root. The aim of the procedure is to reduce the inflammation of the nerve root and also block the pain impulse from travelling up the nerve to the brain. This will then bring partial or complete (but temporary) relief of the pain.
READ MOREA cervical RFR is performed for pain that is caused by damaged facet joints (see the section Anatomy of the Spine). The aim of the operation is to temporarily paralyse the very small nerves that supply the facet joint of pain sensation. This will then bring partial or complete (but temporary) relief of the pain, spasms and referred pain that these damaged facet joints can cause.
READ MORETREATING NECK PAIN - INVASIVE TREATMENT
YOUR NECK OPERATION
You have agreed to surgery for your neck problem. The extent, complications and outcomes have been addressed by your specialist.
The following information will be helpful in preparing for your surgical procedure.
Pre-operative information
Have you informed your specialist of any other conditions and medications including dosages that you are taking? If not, please do and do not forget to have this information at pre-admission and when you are seen by the anaesthetist.
An anterior cervical discectomy (ACD) is an operation that is performed for a herniated cervical intervertebral disc (slipped disc) which is causing pressure on the related nerves or the spinal cord. The aim of the operation, which is performed from the front of the neck, is to remove this pressure by taking away the disc, the disc prolapse and any bony outgrowths/osteophytes that may be present. In some cases several discs need to be removed.
READ MOREA cervical disc arthroplasty is performed for a cervical slipped disc. The reason why your specialist performs this procedure is because there is pressure on a nerve root that needs to be relieved. The aim of the operation is to remove the whole of the disc from the front of the neck. The secondary aim is to preserve spinal movement on that specific level by replacing the disc with an artificial disc prosthesis.
READ MORE A decompression of the spinal canal, that carries the spinal cord, is carried out because of compression of nerves by a variety of pathological mechanisms.
READ MOREThere are several reasons for performing a posterior neck fusion. Generally, this operation is performed for instability of the cervical spine (neck). The instability could be the result of trauma, but it could also be the result of extensive surgery that was needed to decompress spinal nerves. In other cases, the cervical spine has become unstable due to a degenerative condition such as rheumatoid arthritis.
READ MOREA foraminotomy is an operation performed to relieve pressure on a spinal nerve as it exits the spine through an opening called the foramen. When this operation is performed in the neck region, it is called a cervical foraminotomy.
READ MORE
NECK EXERCISES AFTER SURGERY
Before you start with these exercises, allow your physiotherapist to go through them with you to make sure that you do them correctly. She will also adapt them if necessary. Loosening exercises
Loosening exercise 1
All movements must be comfortable and must not cause pain.
