The patient was operated by me for extruded disc L4-5 27-December-2008. The patient was doing will until he came to the clinic 07-April-2016 complaining of LBP with left sciatica for 1 day agonizing down to the left knee with numbness all toes left foot with positive cough sign. The patient now has arterial hypertension in Coveram 10/5 once daily.

On examination: the patient is limping with exaggerated scoliotic stance. SLRS was 30 degrees with pain in the left. There is weak dorsi and planterflexion left foot 3/5. Hypalgesia both left L5, S1 roots.

The patient was sent for investigations and MRI lumbar spine performed 09-April-2015 showing huge recurrence of L4-5 with left foraminal and extraforaminal occlusion. Dynamic studies were normal and Lab investigations showed ESR 50 mm/h with CRP 6 mg/L.

The old incision refreshed and dissection carried out down to the left upper corner of the previous bone defect and neurolysis of the left L5 root was achieved. The extruded disc was removed lateral to the axilla and the far lateral extraforaminal part removed. Left sided cleaning of the disc space was achieved. Using MultiGen, a bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to left L5 root was achieved using 2 bended catheters 10 mm exposed length. The electrodes were put both lateral to the axilla. Stimulation of the root with 4 V showed slight response, but with 5 V brisk response. Routine closure of the wound.

Smooth postoperative recovery. The power of left foot became normal. The patient is sciatica free. He 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 49th 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.

If there is scar, it hard to predict the correlation between the root response to stimulation amplitude and the postoperative recovery. All the modalities of stimulation were tested, monopolar, bipolar and at times even 8 V did not show any response. Only direct contact to healthy parts of the root gave response. The scar blocked the motor response even to high currents.