The patient came to the clinic 13-February-2017 complaining of LBP for 2 months with right sciatica down to the right ankle. MRI lumbar spine performed 15-January-2017 showing bulge L2-3, 3-4, L5-S1 with huge extruded disc L4-5 with right downward migration.

On examination, the patient is limping with exaggerated scoliotic stance. SLRS was 90 degrees both sides without pain. There is weak dorsiflexion right foot 3/5.

Foraminotomy right L5 root. The extruded disk was removed lateral to the axilla of the right L5 root extending down. Right sided cleaning of L4-5 was performed. Using MultiGen, bipolar motor stimulation of the right L5 was achieved with 1.9 V. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to right L5 root was achieved using 2 bended catheters 10 mm exposed length. Further bipolar motor stimulation of the right L5 was achieved with 1.7 V. Routine closure of the wound.

Smooth postoperative recovery. The power of right foot normalized and she was sciatica free. She 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 109th 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 there was slight improvement of the threshold of stimulation power of motor stimulation of the right L5.

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 anaesthesia protocol also the same.