The patient came to the clinic 14-April-2011 complaining of LBP for 1 year and right sciatica for 1 month. MRI performed 11-April-2011 showing bulge L5-S1 and extruded disk L4-5 with right downward migration. The patient at that time was limping with mild scoliotic stance. SLRS was 30 degrees with pain with no motor or sensory deficit. He was treated conservatively and disappeared. The patient then came 28-July-2016 complaining of LBP with right sciatica for 1 month.

On examination: the patient is limping with same scoliotic stance. SLRS was 15 degrees right side and 30 degrees left side with pain. There is weak dorsiflexion right foot -4/5.

The patient was sent for investigations and MRI lumbar spine performed 28-July-2016 showing enlargement of the previous extrusion with right downward migration at L4-5 level and bulge L5-S1 more to the left. Dynamic studies and lab investigations demonstrated high uric acid 7.2 mg/dL.

Using the C-arm, the L4-5 level was identified and decompressive laminectomy L4 and L5 was done. Foraminotomy right L5 root was achieved. The extruded disk was removed from right side and right sided cleaning of L4-5 was performed. Using MultiGen, bipolar motor stimulation of right L5 root was achieved with 1.6 V in the right root. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to right L5 root was achieved using 2 bended catheters 10 mm exposed length. Further motor stimulation done to the same root and the response was 1.5 V in the right. 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 69th 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 slight decrease of the threshold of stimulation power of motor stimulation after the procedure.