The patient was operated by me 28-May-2014 for extruded disc L5-S1 with right foraminal occlusion. The patient then came 24-April-2018 telling that she progressed LBP the last 2 months with left sciatica, not reaching below the left knee with further exacerbation the last 3 days. MRI lumbar spine bad quality performed 22-April-2018 showing as be a huge extrusion L1-2 and L2-3 left side. The patient now in Palestine. She is a known diabetic under treatment.

The patient then came 05-May-2018 with MRI lumbar spine done 05-May-2018 showing huge extruded disc L2-3 with left foraminal occlusion and small extrusion L1-2. Dynamic studies ruled out overmobility. ESR was 39 mm/h and CRP 15.6 mg/L. SLRS was 90 degrees without pain both sides. There is weak dorsiflexion left foot 4/5. Left psoas and left quadriceps muscles -4/5. The patient walking bended anterior with difficulty. Zinnat was started and she was seen by cardiologist.

Left L2 hemilaminectomy was performed with foraminotomy left L2 and L3 root. The extruded disc of L2-3 was removed and intradiscal cleaning of L2-3 was achieved from the left. Inspection of the L1-2 disc space was performed. Using MultiGen, bipolar motor stimulation of the left L3 root was achieved with 2.0V. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to the left L3 root was achieved using 2 bended catheters 10 mm exposed length. Further bipolar motor stimulation of the left L3 root was achieved with 1.5 V. Routine closure of the wound.

Smooth postoperative recovery. The power of left foot became normal. She was sciatica free. She was sent to the ward.

This is the 150th case using the BPRF mode with MultiGen. This procedure regained routine acceptance.  It became a usual part of the spine and peripheral nerves 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 tells that the electrodes did not migrate during the procedure and the nerve is functioning properly. Here the threshold of stimulation power of motor stimulation of the affected root after application was better.

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.

It is unclear why the roots have several motor response with different patients, despite the fact that the neurological status is the same and the anesthesia protocol also the same.

It could be that the nerve is recovering minute by minute after decompression and this can explain why the motor conductivity is improving after the BPRF application, which require 4 minute session in most cases.