The patient came to the clinic 02-April-2016 complaining of LBP for 24 years, left sciatica for 2 months down to the lateral aspect left foot. The pain is continuous awakening her during night. MRI lumbar done 28-March-2016 showing extruded disc L4-5 with left foraminal occlusion and severe segmental stenosis. She can walk less than 300 meters with difficulty and pain. The patient is a known hypertensive under treatment for 2 years and having bronchial asthma. 

On examination: the patient is limping with exaggerated scoliotic stance. SLRS was 30 degrees left side with pain. There is weak dorsiflexion left foot 3/5, and  -4/5 right foot. There is varicose veins both legs.

The patient was sent for investigations. Dynamic studies ruled out overmobility. Uric acid was 7.0 mg/L with hyperlipidemia.

Decompressive laminectomy of L4 and upper half of L5 was achieved. Foraminotomy both L5 roots was done. The disc space was inspected and overmobility was negative. The extruded disc was removed from left side and left sided cleaning of L4-5 was achieved. 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 4 bended catheters 10 mm exposed length. Stimulation of the right nerve was achieved with 1.2 V and the left with 0.8 V. 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 still have an estimated postoperative recurrence around 7%, because the disc space is still not shallow.

This is the 53rd 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.