The patient came to the clinic 08-October-2012 complaining of LBP for one month without sciatica. The pain when sleeping and at the morning. He could walk freely. On examination at that time, he was limping with scoliotic stance. There slight pain when turning the head to both sides and up. There is weak dorsiflexion both feet 4/5 with diabetic neuropathy with diminished sensation of the toes both feet. The patient is a known diabetic for 20 years  under treatment. He had trauma to the right hip and fixation was done 2006. The patient was sent for investigations and MRI done 08-Ocober-2012 showing bulge L2-3, 3-4, 4-5 and L5-S1. Dynamic studies were normal. The patient had nephrologic problems for what he was sent for urological surgeon. The patient then came 07-March-2015 telling that he was operated for Ca prostate  in November-2014 with conflicting histologic results. After this surgery he progressed neck pain with both upper limbs pain. MRI of the cervical spine performed 05-March-2015 showing bright spot in the spinal cord behind C4-5 with small disci all over. The patient progressed incontinence after surgery with dripping of urine. On examination at this stage, there was pain when turning the head to all directions except when looking down. There was weak grip left hand 3/4 and weak both triceps 4/5 with no signs of myelopathic syndrome. The patient still in chemotherapy and he was sent for new MRI of the cervical spine with SVS (Single voxel spectroscopy) which ruled out the malignant nature of the spinal cord lesion. The patient was kept in conservative treatment. The patient then came 20-February-2016 telling that he got deterioration of the LBP with bilateral sciatica with difficult walking and using crutches for the last 2 weeks. MRI lumbar spine performed 30-January-2016 bad quality showing lumbar canal stenosis L4-5. MRI the cervical spine showing the old data. 

On examination: the patient is limping with exaggerated scoliotic stance. SLRS was 90 degrees without pain. There is weak dorsiflexion both feet 4/5 and analgesia below both knees. The patient now in no chemotherapy for 2 months.

The patient was sent for MRI lumbar spine and the pelvis. They were preformed the same day showing severe stenosis at L2-3, 3-4 and L4-5. There is remnant of the Ca prostate at he floor of the urinary bladder. He was sent for consultation to his urologic surgeon.  

Skeletonization of L2,3 and L4. Check for overmobility was negative. Decompressive laminectomy L2,3,4 and upper third of L5. Bilateral foraminotomy L3,4,5 roots was achieved. The bone of the patient was abnormally bleeding, that it was necessary to wax it after every bony manipulation. This could be due to the chemotherapy. Using MultiGen, a bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to all exposed roots was achieved using 4 bended catheters 10 mm exposed length. Routine closure of the wound.

Smooth postoperative recovery. The power of both feet became normal. The patient is sciatica free. He was sent to the ward.

The patient has old standing diabetes mellitus and undergoing chemotherapy. These factors will play negative role in his recovery.

This is the 36th 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.