The patient came to the clinic 18-October-2016 complaining of LBP and right sciatica last week down with numbness big toe right foot. MRI lumbar spine performed 17-October-2016 showing huge extruded disk L4-5 with right  up and downward migration causing foraminal occlusion.

On examination, the patient was limping with exaggerated scoliotic stance. SLRS was 40 degrees with pain in the right and 70 degrees in the left. There is drop right foot and planterflexion 3/5 with analgesia right L5 root.

Right L4 hemilaminectomy. Right L5 and S1 foraminotomy was achieved. The extruded disk was removed lateral to the axilla under the S1 root and extending up to compress the right L5 root. Right sided cleaning of L5-S1 was performed.  Using MultiGen, bipolar motor stimulation of right L5 was achieved with 1.5 V and S1 was responding to 1.1 V. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to right L5 and S1 roots was achieved using 4 bended catheters 10 mm exposed length. Further motor stimulation done to the same roots and the response was 1.5 V to the right L5 root and 1.0 V to the right S1 root. 4 ml PRP was applied to the roots area. Routine closure of the wound.

Smooth postoperative recovery. The power of right foot improved in planterflexion and he was sciatica free. Dorsiflexion of the foot still the same. 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 88th 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 no change 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.

This is the second case with drop foot, time will tell how effective BPRF and PRP in this case.