The patient came to the clinic10-October-2016 complaining of LBP for 8 years with left sciatica intermittent course. Exacerbation last 5 days with agonizing left sciatica.

On examination, the patient was limping with exaggerated scoliotic stance. SLRS was 10 degrees with pain in the left. There is weak left foot dorsi and planterflexion 3/5 with hypalgesia left L5, S1 territories and absent AJ left side.

The patient sent for investigations and MRI lumbar spine performed the same day showing huge extruded central disk L4-5 more to the left with downward migration.

Left L5 foraminotomy was achieved. The extruded disk was removed lateral to the axilla under the L5 root. Left sided cleaning of L4-5 was performed.  Using MultiGen, bipolar motor stimulation of left L5 was achieved with 10 V due to deep sedation and muscle relaxant. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to left L5 root was achieved using 2 bended catheters 10 mm exposed length. Further motor stimulation done to the same root and the response was 4 V in the left L5 with more brisk response mostly due to wearing effect of the muscle relaxant. Routine closure of the wound.

Smooth postoperative recovery. The power of left foot improved and she was sciatica free. She was sent to the ward.

The patient still have an estimated postoperative recurrence around 7%, because the disc space is still not shallow.

This is the 85th case using the BPRF mode with MultiGen. This procedure regained routine acceptance.  It became a usual part of the spine surgery. Click here for reference.

It still unclear to evaluate the differences of pre and post application motor responses. The only sure thing that it tell that the electrodes did not migrate during the procedure and the nerve is functioning properly. Here there was no change of the threshold of stimulation power of motor stimulation after the BPRF.

With accumulation of data, it became clear that the irritated nerve with aberrant currents running in the C fibers up, not only causing no change or elevation of the required voltage to achieve motor response, but they could cause the preoperative weakness. Ablation of such currents results in facilitation of the motor response and improvement of function with disappearance of pain.

This case demonstrate the importance of coordination with anaesthesia to wear off completely the muscle relaxant effect before proceeding with motor stimulation.

ILLICO retractor system was abandoned, because it only prolongs the time of surgery without additive advantage.