The patient came to the clinic 18-April-2016 complaining of LBP with right sciatica for 15 years with exacerbation last 7 month. He is using crutches for 6 months and the pain reaching the big toe right foot. He is a known diabetic for 4 years and hypertensive for 30 years.

On examination: the patient is not limping now with mild scoliotic stance. SLRS was 30 degrees in the right with pain and 80 degrees left side without pain. There is weak dorsiflexion both feet -4/5 and dyseasthesia of the right L5 territory.

The patient was sent for investigations and MRI lumbar spine performed 18-April-2016 showing huge wide-based extrusion L5-S1 more to the left. Dynamic studies unremarkable. The patient was sent for cardio evaluation.

Using the C-arm, the L5-S1 level was identified and foraminotomy both S1 roots was achieved. The extruded disk was removed from left side and left sided cleaning of L5-S1 was performed. Inspection of the right side was unremarkable. Using MultiGen, stimulation of both nerves was achieved with 1.3 V. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to both S1 roots was achieved using 4 bended catheters 10 mm exposed length. Further motor stimulation done to the same roots and the responses were for 1.0 V noted. 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 60th 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.