The patient came to the clinic 18-January-2016 complaining of left sciatica for 18 months  with minimal LBP with exacerbation of the left sciatica the last day down to all toes left foot with numbness. MRI lumbar spine done 17-August-2014 showing extruded disc L4-5 with left foraminal occlusion.

On examination: the patient is in agonizing pain, limping with exaggerated scoliotic stance. SLRS was 40 degrees with pain in the left. There is weak dorsiflexion left foot 3/5 and 4/5 right foot. Positive cough sign. There is hypalgesia left L5 root territory.

The patient was sent for new investigations and MRI lumbar spine performed 18-January-2016 showing extruded disc L4-5 with left downward migration. Dynamic studies ruled out the presence of overmobility.

Left L4-5 hemiflavotomy with foraminotomy left L5 root. The extruded disc was removed lateral to the axilla and left sided intradiscal cleaning of L4-5 was achieved.  Using MultiGen, a bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to the left L5 root was achieved using 4 catheters 5 mm exposed length, attached to 2 tubes  12 mm length incised longitudinally and the catheters tips fixed to the corners. This procedure took  less effort in comparison to the previous procedure,   to achieve and fixating the device above the root was necessary for the 4 min time.   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 for observation.

The patient still has an estimated postoperative recurrence around 7%, because the disc space still not completely shallow.

The 23rd case with persisting sciatica enforced us to go further with the BPRF protocol as mentioned.

This is the 25th case using the BPRF mode with MultiGen and the second with double BPRF. This procedure regained routine acceptance  it will be a usual part of the spine surgery. Click here for reference.