The patient came to the clinic 09-January-2016 complaining of LBP for 7 years with exacerbations last month with left sciatica down to all toes left foot with numbness. MRI lumbar spine done 25-January-2009 showing bulge L3-4 and L4-5.

On examination: the patient is in agonizing pain. She is limping with exaggerated scoliotic stance. SLRS was 20 degrees with pain in the left. There is weak dorsiflexion left foot 3/5 and planterflexion same foot 4/5. Positive cough sign. There is hypalgesia left L5 root territory.

The patient was sent for new investigations and MRI lumbar spine performed 10-January-2016 showing extruded disc L5-S1 with left downward migration. Dynamic studies ruled out the presence of overmobility. ESR was 30 mm/h.

Left L5-S1 hemiflavotomy with foraminotomy left S1 root. The extruded disc was removed lateral to the axilla and left sided intradiscal cleaning of L5-S1 was achieved.  Using MultiGen, a bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to the left S1 root was achieved using 4 catheters 5 mm exposed length, attached to tube 12 mm length incised longitudinally and the catheters tips fixed to the corners. This procedure took huge effort to achieve and fixating the device above the root was necessary for the 4 min time.   Routine closure of the wound.

Smooth postoperative recovery. The power of left foot became normal. The patient is sciatica free. She was sent to the ward for observation.

The patient still has an estimated postoperative recurrence around 7%, because the disc space still not completely shallow.

The 23d case with persisting sciatica enforced us to go further with the BPRF protocol as mentioned.

This is the 24th case using the PRF mode with MultiGen. This procedure regained routine acceptance  it will be a usual part of the spine surgery. Click here for reference. In his case it seems that the procedure was not effective.