The patient came to the clinic 27-April-2014 complaining of LBP with bilateral sciatica for 10 years with exacerbation last 4 years. MRI lumbar spine performed 21-April-2014 showing huge extruded disc L4-5 with severe segmental stenosis with bulge L5-S1. Dynamic studies were normal. The patient at that time was not limping with no scoliotic stance. There was weak dorsiflexion both feet -4/5. He was advised to undergo surgery, but escaped. The patient then came 24-May-2016 with the same complains with bilateral sciatica more the right.

On examination: the patient is not limping now with mild scoliotic stance. SLRS was 80 degrees in the right with pain and 90 degrees left side without pain. There is weak dorsiflexion both feet 3/5 and planterflexion right foot 4/5.

The patient was sent for investigations and MRI lumbar spine performed 25-May-2016 showing huge wide-based extrusion L4-5 with severe segmental stenosis and bulge L5-S1 more to the right. Dynamic studies unremarkable.

Using the C-arm, the L4-5 level was identified and foraminotomy both L5 roots was achieved. There was a tear due to severe stenosis about 10 mm, which was repaired by nylon 6 zero. The extruded disk was removed from both sides and bilateral cleaning of L4-5 was performed. Right L 5 hemilaminectomy with foraminotomy right S1 root. The extruded disc was removed and right sided cleaning of L5-S1 was achieved. The disc space was very shallow. Using MultiGen, stimulation of both L5 nerves was achieved with 1.5 V. The right S1 was responding to 2.5 V. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to both L5 and right S1 roots was achieved using 4 bended catheters 10 mm exposed length. Further motor stimulation done to the same roots and the responses were 1.3 V for the right L5 root, 1.5 V for the left and 1.8 for the right S1 root. Routine closure of the wound.

Smooth postoperative recovery. The patient is sciatica free. The power of both feet normalized and he 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 62nd 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 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.