The patient came to the clinic 24-December-2015 complaining of LBP with right sciatica for 2 months. At that time he was not limping with normal stance with SLRS 20 degrees with pain in the right and weak dorsiflexion right foot 4/5. He was sent for neurophysiologic evaluation and MRI lumbar spine performed 29-December-2015 showed an extruded disk L5-S1 with right downward migration. The patient came then 11-February-2016 telling that he got improvement, for what he was advised to keep in conservative treatment. The patient then came 17-April-2016 telling that pain-killers caused to him gastritis. He was not limping, but having exaggerated scoliotic stance with SLRS 15 degrees with pain and weak dorsiflexion right foot -4/5. He was sent for new investigations and came 22-August-2016. MRI lumbar spine performed 22-August-2016 showing extruded disk of L5-S1 central with huge right downward migration.

Foraminotomy right S1 was achieved. The extruded disk was removed lateral to the axilla from the right side and right sided cleaning of L5-S1 was performed. The depth of cleaning was 40 mm.  Using MultiGen, bipolar motor stimulation of right S1 root was achieved with 0.9 V. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to right S1 root was achieved using 2 bended catheters 10 mm exposed length. Further motor stimulation done to the same root and the response was 0.9 V in the right with more brisk response. Routine closure of the wound.

Smooth postoperative recovery. The power of right foot normalized and he was sciatica free. 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 73rd 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 procedure in the right side.

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.