The patient came to the clinic 19-June-2013 complaining of LBP for 4 years with left sciatica for 1 year with numbness big toe both feet, more the left. He could walk more than 200 meters. LSS X-ray showed suspected retrolisthesis L3-4 MRI lumbar spine done 25-February-2013 showing extruded disc L2-3 with lumbar canal stenosis L2-3, L3-4 and L4-5. He is a known diabetic for 10 years in treatment. He has rheumatoid manifestations and Vit D3 deficiency.

On examination: the patient was limping with exaggerated scoliotic stance. The patient has left sided sciatica, but the SLRS was 65 degrees in the right and 80 degrees in the left. Weak dorsiflexion right foot 4/5 and left foot 3/5. There is diabetic neuropathy with decreased sensation below both knees. The patient was initially against surgery, for what new investigations were not performed.

The patient then came 23-August-2015 telling that he got agonizing right sciatica down to the right knee with inability to walk the last 6 days. MRI done 01-June-2015 showing extruded disc L3-4 with stenosis.

On examination: the patient is walking with help of one person with crutches. He has bended posture anterior and limping. SLRS was 10 degrees with pain in the right  and 80 degrees in the left. All prescribed medications are not effective.

The patient was sent for investigations. MRI of the lumbar spine performed 23-August-2015 showing extruded disc L3-4 more to the right with severe stenosis L2-3 and L3-4. Dynamic studies ruled out segmental overmobility. Cardiac consultation performed and anticoagulation stopped.

Decompressive laminectomy L3,4, upper half of L5 and lower third of L2. Foraminotomy L4 roots both sides. The extruded disc of L3-4 was removed from the right side lateral to the axilla. Right sided cleaning L3-4 disc space. Using MultiGen with Pulsed mode RF 240 sec. 42 degrees Celsius and 2Hz 50 was applied to the axilla of right L4 root. Routine closure of the wound.

Smooth postoperative recovery. The power of both feet became normal. The patient was sent to the ward.

The patient still has an estimated postoperative recurrence around 7%.

The patient performed several times MRI investigations and they were variable in seeing and reporting. It is well known that the spine could change over time, but the quality of MRI images and the scanners differ and could give several different readings.

How PRF using MultiGen will affect the pain generation. Time will tell.