Inomed Stockert Neuro N50. A versatile
RF lesion generator and stimulator for
countless applications and many uses
Multigen RF lesion generator .
22-OCTOBER-2016 AHMAD MAHMOUD AL-LOZI 46 YEARS HUGE
EXTRUDED L4-5 WITH LEFT DOWNWARD MIGRATION.
Anamnesis
The patient came to the clinic 18-October-2016
complaining of LBP LBP and left
sciatica for 4 years with agonizing left sciatica
with inability to walk the last 4 days with
numbness all toes left foot. MRI lumbar spine
performed 15-October-2016 showing huge
extruded disk L4-5 with left
foraminal occlusion and downward migration.
On examination, the patient in wheelchair. SLRS was
60
degrees with pain in the right and 5 degrees
with more pain in the left. There is weak
left foot dorsi and planterflexion -3/5 with
hypalgesia left L5, S1 territories.
Left L5 foraminotomy
was achieved. The extruded disk was removed
lateral to the axilla under the L5 root. Left sided cleaning of L4-5 was
performed. During exposure there was a
tiny dural defect though which CSF came out.
Coagulation of the point with elevation the leg
area of the table stopped the leak. After the
surgery the patient was put in head up position
and Valsalva maneuver showed no CSF leak, for
what muscle flap was put over the defect to
avoid postoperative CSF leak. Using MultiGen, bipolar motor stimulation of
left L5 was achieved with 1.7 V. A
bipolar pulsed mode
RF with 42 Celsius, 240 sec, 2 Hz and 20 msec
duration to left L5 root was achieved using
2 bended catheters 10 mm exposed length. Further
motor stimulation done to the same root and the
response was 1.6 V in the left L5 with more
brisk response. Routine closure of the
wound.
Smooth postoperative recovery. The power of
left foot improved and he was sciatica free.
He was sent to the ward.
MultiGen
Comments
The patient still have an estimated
postoperative recurrence around 7%, because the disc space
is still not shallow.
This is the 90th 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. Here there was slight improvement of the threshold of
stimulation power of motor stimulation after the BPRF.
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.
Skyra MRI with all clinical applications in the run since 28-Novemeber-2013.
Inomed Riechert-Mundinger System, with three point
fixation is the most accurate system in the market. The microdrive and
its sensor gives feed back about the localization.
Inomed MER system
Leica HM500
The World's first and the only Headmounted Microscope.
Freedom combined with Outstanding Vision, but very bad video recording and
documentation.
After long years TRUMPF TruSystem 7500 is running with in the neurosuite at
Shmaisani hospital starting from 23-March-2014
Notice: Not all operative activities
can be recorded due to lack of time.
Notice: Head injuries and very urgent surgeries are also
escaped from the plan .