The patient was operated by me 19-April-2006 for LCS L2-3, L3-4 and was doing well. The she came to the clinic 10-December-2016 complaining of right sciatica the last 6 months with both hips pain and inability to walk more than 100 meters. Recent lumbar X-ray performed showing old wedged fracture of L1 due to osteoporosis and she is in anti-osteoporotic treatment. She has arterial hypertension for 5 years in diuretics and using Zyloric 300 mg daily.

On examination: the patient is limping with mild scoliotic stance. She has urgency and frequency for 5 years, SLRS was 30 degrees right side with pain and 40 degrees in left side with more pain. There is weak dorsiflexion right foot 3/5, dorsiflexion left foot and planterflexion both feet 4/5.

The patient was sent for investigations and MRI lumbar spine performed 12-December-2016 showing severe lumbar canal stenosis L4-5. Dynamic studies showed ankylosing spondylitis with anterior fusion of L1-2 with no signs of overmobility. MRI left knee showed Baker cyst with synovitis and torn menisci. CRP was 11 mg/L, ESR was 28 mm/h.

A new incision under the old one was performed  and laminectomy of L4 and upper 2/3d of L5 was achieved. Foraminotomy both L5 roots was done. The disc space was inspected and overmobility was negative. Using MultiGen, a bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to both L5 root was achieved using 2 bended catheters 10 mm exposed length to the right and 5 mm length to the left. Stimulation of the nerves even with 10 volts revealed no response due to miss-coordination with anaesthesia ( The patient in muscle relaxants). Routine closure of the wound.

Smooth postoperative recovery. The patient is sciatica free. The power of both limbs normalized and she was sent to the ward.

The patient showed progression of the stenosis after 10 years. It seems that this pathology is a slowly progressive one and triggered by gout, osteoporosis.

This is the 51st 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.