The patient was operated by me 20-June-2012 for huge recurrent disc L4-5 and was doing well until the last 4 months got left sciatica. He came to the clinic 18-February-2016 telling that his condition is deteriorating with numbness of the left foot with drop foot for 2 months. MRI done 06-February-2016 showing huge central extruded disc L3-4  with left downward migration and causing severe segmental stenosis. Dynamic studies not convincing to rule out overmobility. 

On examination: the patient is limping with exaggerated scoliotic stance. SLRS was 85 degrees in the left with pain. There is weak dorsiflexion right foot 4/5 and drop left foot and planterflexion both feet 4/5. Knee abduction right leg 4/5 and left leg 3/5. Hypalgesia of both L5 and  S1 territories.

Skeletonization of L3 and L4. Check for overmobility was negative. Decompressive laminectomy L3 and upper third of L4. The extruded disc L3-4 was removed from the left side and bilateral cleaning of L3-4 was achieved. Using MultiGen, a bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to both L4 roots was achieved using 4 bended catheters 10 mm exposed length. Routine closure of the wound.

Smooth postoperative recovery. The power of left foot still the same, but other involved parts fully recovered. The patient is sciatica free. He was sent to the ward.

The patient have an estimated postoperative recurrence around 7% because the disc space is still not shallow.

This is the 35th 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.