The patient came to the clinic 31-May-2016 complaining of LBP and right sciatica for 2 years with bilateral sciatica for 45 days more the right. MRI lumbar spine performed 02-May-2016 showing huge extruded disc L5-S1 with with right foraminal occlusion with small extrusion L3-4 left side.

On examination: the patient is limping with exaggerated scoliotic stance. SLRS was 65 degrees both sides with pain. There is weak dorsiflexion right foot 4/5 and hypalgesia right L5 and S1 territories.

The patient was sent for investigations and repeat MRI showing the small extrusion of L3-4 left and extruded disc L5-S1 with right downward migration. Dynamic studies were negative. ESR 30 mm/h and CRP was 40 mg/L. The patient was started in antibiotics immediately to prevent the hidden source of infection.

Using the C-arm, the L5-S1 level was identified and foraminotomy right S1 root was achieved with preservation and reflection of the ligamentum flavum to the left trying to keep the epidural fat. The extruded disk was removed from right side and right sided cleaning of L5-S1 was performed. The disc material was soft in consistency.  Using MultiGen, stimulation of right S1 root was achieved with 0.9 V. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to right S1 roots was achieved using 2 bended catheters 10 mm exposed length. Further motor stimulation done to the same root and the response was 0.8 V. Routine closure of the wound.

Smooth postoperative recovery. The patient is sciatica free. The power of right foot normalized and he 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 64th 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.