The patient came to the clinic 17-March-2016 complaining of LBP for 10 years. Left sciatica for three years progressing the last three months. MRI lumbar spine performed 31-March-2013 and 05-May-2015 showing extruded disc L5-S1 with suspicion of retrolisthesis at this level. The patient has dysmenorrhea and metrorrhagia for long time.

On examination: the patient has Trendelenburg gait with exaggerated scoliotic stance. She has also pain in the left ilioinquinal area and pain shooting to the L4 territory. She has hypalgesia below the left knee and left side of the suprapubic area with hypalgesia right perianal area involving the right S1,2,3,4 . SLRS was 30 degrees with pain in the left. There is weak dorsi and planterflexion left foot 3/5 with weak abduction of the left hip.

The patient was sent for MRI lumbar spine and neuro MRI of the pelvis. It was preformed 18-February-2016 showing the same extruded disc L5-S1 with left minimal foraminal compression. Dynamic studies ruled out overmobility. MRI of the pelvis showed huge scattered adenomyosis of the uterine with lesions of the cervix. Spectroscopy of the intrauterine lesions showed high levels of Choline. The patient was sent for gynecological consultation and smear done ruling out malignancy.

Typical hysterectomy incision was created and the peritoneum opened vertically. The patient in Trendelenburg position. The uterus was huge and it was mandatory to perform hysterectomy including the cervix with preservation of the ovaries and removal of the fimbriae. The promontory was identified and check level by C-arm was confirmed. That because the patient has lumbarization of S1. Discectomy L5-S1 was performed and drilling down in the left corner to obtain maximum decompression of the left S1 root. Using MultiGen, a bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to left S1, 2, 3 roots from the anterior exit was achieved using 2 bended catheters 10 mm exposed length. Stimulation of each nerve was achieved with 1.3 volt. The obturator and left femoral nerves were stimulated also. Routine closure of the wound.

Smooth postoperative recovery. The power of left foot became normal. The patient is sciatica free. She was sent to the ward.

The patient having an estimated postoperative recurrence around below 7%, because the disc space was attacked from anterior.

This is the 45th 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.

The standard entry points for laparoscopic procedure are not compatible with disc surgery, since the angle of view to L5-S1 is different in direction. The disc surgery instrumentations must be fitted to be friendly with laparoscopic technique.