The patient came to the Emergency Shmaisani hospital at 3.00 a.m. 03-November-2016 complaining of LBP and right sciatica for 4 weeks with agonizing right sciatica with inability to walk or set the last day. MRI lumbar spine performed 02-November-2016 showing huge extruded disk L4-5 central with right foraminal occlusion and downward migration. The patient is a known hypertensive in Adalat 10 mg once daily for 2 years and he is in Baby Aspirin.

On examination, the patient is bedridden. SLRS was 0 degrees with pain in the right and 5 degrees with pain in the left. There is weak right foot dorsi and planterflexion -4/5.

Right L5 foraminotomy was achieved. The extruded disk was removed lateral to the axilla under the L5 root. Right sided cleaning of L4-5 was performed. Using MultiGen, bipolar motor stimulation of left L5 was achieved with 1.5 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 1.2 V in the right L5 with more brisk response. Routine closure of the wound.

Smooth postoperative recovery. The power of right foot improved and he was sciatica free. 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 91st 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 considerable 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.