The patient came to the clinic 17-October-2016 complaining of LBP since 1994 with exacerbation of LBP and left sciatica last 2 months with agonizing bilateral more left sciatica with inability to walk. MRI lumbar spine performed 05-September-2016 showing huge extruded disk L4-5 wide based with left foraminal occlusion. MRI dorsal normal, cervical bulge diski C4-5 and C6-7.

On examination, the patient was limping with exaggerated scoliotic stance. SLRS was 80 degrees with pain in the right and 80 degrees with more pain in the left. There is weak left foot dorsi and planterflexion 3/5 with weak dorsiflexion right foot 4/5 and absent AJ left side.

The patient sent dynamic studies and lab investigations which were normal.

Partial lower 1/4th laminectomy L4. Left L5 foraminotomy was achieved. The extruded disk was removed lateral to the axilla under the L5 root. Left sided cleaning of L4-5 was performed.  Using MultiGen, bipolar motor stimulation of left L5 was achieved with 1.2 V. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to left L5 root was achieved using 2 bended catheters 10 mm exposed length. Further motor stimulation done to the same root and the response was 1.2 V in the left L5 with more brisk response. The same procedure repeated to the right L5 root and the response was 1.1 V before and after the ablation. Routine closure of the wound.

Smooth postoperative recovery. The power of both feet improved and she was sciatica free. 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 87th 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.

It still unclear to evaluate the differences of pre and post application motor responses. The only sure thing that it tell that the electrodes did not migrate during the procedure and the nerve is functioning properly. Here there was no change of the threshold of stimulation power of motor stimulation after the BPRF.

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.