The patient came to the clinic 14-January-2009 with clinical history of LBP with bilateral sciatica and numbness both feet for 10 years. Exacerbation last 2 years with inability to stand more than 5 minutes. She was limping and dragging the left leg. On examination that time, SLRS was 80 degrees right and 70 degrees left with weak dorsiflexion right foot 4/5 and left foot -4/5 and hypalgesia right L5 root territory. MRI of the lumbar spine performed 19-January-2009 showed spondylolisthesis L4-5 with small extrusion left side. The patient then came 04-August-2010 complaining of neck pain with the same LBP with inability to stand more than 5 min. There was weak grip right hand -4/5 and left hand 4/5. Weak extension both hands 4/5. Both triceps weak 4/5 with hypalgesia median distribution right hand. The power of both legs the same as before with SLRS 70 degrees right and 65 degrees left with pain both sides. The patient was sent for investigations but disappeared. The patient then came 07-September-2015 complaining of left sciatica for 20 days with numbness. MRI lumbar spine performed 06-September-2015 showing spondylolisthesis L4-5 with possible ganglion from the left L4-5 facet joint. 

On examination: the patient is limping with exaggerated scoliotic stance. SLRS was 49 degrees with pain in the left. There is weak dorsiflexion both feet 3/5 and planterflexion both feet 4/5. The patient was sent for previously asked investigations. MRI of the brain performed 12-September-2015 showing ethmoiditis and the cervical showing considerable disc at C5-6 slightly compressing the spinal cord without malacia.

Skeletonization of L3,4 and L5. Transpedicular fixation L4 and L5 was achieved using XIA 3 Stryker screws 6.5x45 mm with bended rods 5.5x60 mm Decompressive laminectomy of L4 and upper third of L5. Foraminotomy of left L5 root. Using MultiGen with PRF mode applied to leftL5 roots with the following parameters: 240 sec, 42 Celsius, 2 Hz 20 millisecond. Distraction in the right side was applied to correct the scoliotic deformity. during tightening of the left upper screw, the left lower screw shifted 2 mm laterally, but it was reduced back and it was still fixed to the bone. MAC Cross connector 42 mm applied and the harvested bone milted and applied lateral to the rods. Routine closure of the wound.

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

The patient has cervical problem, for what positioning was handled with care to prevent spinal cord injury at C5-6.

Pulsed mode radiofrequency still in debate, either it do nothing or it helps reduce the sciatic pain. This is the sixth case with not clear-cut evidence of improving the outcome but with good evidence that it cause no harm to the patient.