The patient came to the hospital 04-March-2018 complaining of agonizing LBP with left sciatica for 12 days down to the left lateral aspect of the knee. The patient is allergic to Voltaren.

On examination, the patient is in agonizing pain, in wheelchair. SLRS was 90 degrees in the right and 70 degrees in the left with pain. There is weak dorsiflexion left foot 4/5 and the left quadriceps 4/5.

The patient was sent for investigations and cardio consultation and MRI lumbar spine done 03-February-2018 showing huge extruded disc L2-3 with left foraminal. Dynamic studies were negative for overmobility.

Foraminotomy of the left L3 root was achieved. The extruded disk was removed lateral to the axilla from left side. Left sided intradiscal cleaning of L2-3 disc space was performed. For the future project, an hexagonal Allen key No 5 was with difficulty going inside the annulus fibrosis defect. Using MultiGen, bipolar motor stimulation of the left L3 root was achieved with 2.6V. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to the left L3 root was achieved using 2 bended catheters 10 mm exposed length. Further bipolar motor stimulation of the left L3 root was achieved with 2.3V. Routine closure of the wound.

Smooth postoperative recovery. The power of the left leg became normal. He was sciatica free. He was sent to the ward.

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

This is the 146th case using the BPRF mode with MultiGen. This procedure regained routine acceptance.  It became a usual part of the spine and peripheral nerves 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 tells that the electrodes did not migrate during the procedure and the nerve is functioning properly. Here the threshold of stimulation power of motor stimulation of the root after application was better.

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.

It is unclear why the roots have several motor response with different patients, despite the fact that the neurological status is the same and the anesthesia protocol also the same.

It could be that the nerve is recovering minute by minute after decompression and this can explain why the motor conductivity is improving after the BPRF application, which require 4 minute session in most cases.