The patient came to the clinic 10-July-2013 complaining of neck pain for 6 months with right cephalic pain. The patient is a known rheumatoid with severe manifestations for 33 years in cortisone. On examination at that time showed neck pain when turning the head to the left with weak right biceps 4/5 and grip, extension of the right hand and right triceps 3/4. Hypalgesia ulnar distribution right hand. The patient was sent for investigations and MRI of the brain was uneventful, but the cervical spine showed spondylolisthesis C3-4 with severe stenosis C3-4. The patient was advised to undergo surgery, but she disappeared. The patient then came 09-October-2016 complaining of deterioration of her condition wit pain when turning the head to the right and downward.

On examination: the patient has weak all muscles both upper limbs including the deltoids 3/5 both sides. There is no myelopathic syndrome.

The patient was sent for investigations and MRI cervical spine performed 11-October-2016 showing escalation of the spondylolisthesis with severe spinal cord compression and malacia of the spinal cord. The patient was sent for cardio evaluation.

Diskectomy C3-4 was performed and the extruded disk was removed. Using MultiGen failed due to narrow angles of the field inside the disk space. 1 cervical cage Solis 6x14x13 was inserted to C3-4 level and REFLEX ACP 18 mm length with 4 fixed screws 4x18 mm were used to fuse and reduce the spondylolisthesis of C3-4. The MultiGen electrodes were inserted lateral to the disc space C3-4 paravertebral and the motor response was 1.5 V in the right and 1.2 V in the left. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to both C3 roots was achieved using 4 bended catheters 10 mm exposed length. The motor response after ablation was the same in the right and 1.1 V in the left.  All stages of surgery were performed with C-arm guidance. Routine closure of the wound.

Smooth postoperative recovery. The power of both upper limbs became better and she was sent to the ward.

The recurrence rate in cervical disk surgery is zero.

This is the 89th 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.

The catheters of MultiGen were difficult to use in this case inside the disk space cavity, but it was achieved paravertebral at the emergence of the roots.

This is the first case using MultiGen in cervical spine outside the body medial to the vertebral arteries.