The patient came to the clinic 23-May-2018 complaining of LBP with bilateral sciatica more to the left for 2 months with deteriorating course. She has micturition dysfunction for 2 years.

On examination: she was limping with scoliotic stance. SLRS was 30 degrees right side and 5 degrees with pain left side. There was weak dorsiflexion both feet 4/5. There was hypalgesia both feet from the ankles. There was also pain in the neck when turning the head to the left and up with weak extension both hands 4/5 and right triceps.

The patient was sent for investigations and MRI cervical spine performed 23-May-2018 showing bulge C3-4, lumbar spine performed showing severe stenosis at L2-3, 3-4 and 4-5. Dynamic studies showing mild retrolisthesis L3-4 with lateral translation.

Skeletonization of L2,3,4 until the the lateral proccessi were visualized. Check for overmobility showed overmobility at all segments. Polyaxial OSI screws 6.5x40 mm were inserted to L4. OSI monoaxial screws 6.5x 40 mm were inserted to L3. OSI monoaxial screws 6.5x45 mm were inserted to L2. Decompressive laminectomy L2,3,4 and upper part of L5 was achieved.  Foraminotomy L2.3.4 roots both sides was carried on. Using MultiGen, bipolar motor stimulation of the right L2 root was achieved with 1.3 V. The left L2 with 1.3 V. The right L3 root with 0.5 V, the left with 2.5 V. The right L4 root with 1.4 V, the left with 1.9 V. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to all these roots was achieved using 4 bended catheters 10 mm exposed length in several settings. Further bipolar motor stimulation of the right L2 root was achieved with 1.2 V. The left L2 with 1.0 V. The right L3 root with 0.5 V, the left with 1.9 V. The right L4 root with 1.4 V, the left with 1.3 V. Using 2 bended rods . lock screws and OSI crosslink, transpedicular fixation L2,3,4 with distraction of the left side to correct the lateral translation was achieved. The harvested bone was put lateral to the rods. Valsalva maneuver was checked for CSF leak.  Routine closure of the wound.

Smooth postoperative recovery. The power of both legs became normal. She was sciatica free. She was sent to the ward.

There is still an estimated postoperative recurrence around 7%, because the disc space height is not shallow.

This is the 162d case using the BPRF mode with MultiGen. This procedure regained routine acceptance.  It became a usual part of the spine and peripheral nerves surgery. Click here for reference.

It still unclear to evaluate the differences of pre and post application motor responses. The only sure thing that it tells that the electrodes did not migrate during the procedure and the nerve is functioning properly. Here the threshold of stimulation power of motor stimulation of the affected roots after application dramatically improved, showing the high threshold of motor stimulation of the clinically affected roots.

With accumulation of data, it became clear that the irritated nerve with aberrant currents running in the C fibers up, not only causing no change or elevation of the required voltage to achieve motor response, but they could cause the preoperative weakness. Ablation of such currents results in facilitation of the motor response and improvement of function with disappearance of pain.

It is unclear why the roots have several motor response with different patients, despite the fact that the neurological status is the same and the anesthesia protocol also the same.

It could be that the nerve is recovering minute by minute after decompression and this can explain why the motor conductivity is improving after the BPRF application, which require 4 minute session in most cases.