Inomed Stockert Neuro N50. A versatile
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Multigen RF lesion generator .
25-JANUARY-2017 HIBA HASAN SALEEM 32 YEARS EXTRUDED
DISC L4-5 WITH LEFT FORAMINAL OCCLUSION.
The patient came to the clinic 14-January-2017
complaining of LBP for 20 days with left leg
edema with left sciatica. MRI lumbar spine performed
03-January-2017 showing extruded disc L4-5 with
left foraminal occlusion. U/S ruled out DVT. The
patient is allergic to Voltaren group, She is in
L-thyroxin 100 microgram daily for 5 years She
was treated for UTI and Amikacin and Furdim
caused allergic reaction.
On examination, the patient is limping with exaggerated scoliotic stance. SLRS
was 30 degrees right side with pain and 15
degrees in the left with more pain. There is weak
left foot dorsiflexion 3/5. There is weak
quadriceps both legs 4/5.
The patient was sent for investigations: MRI
dorsal spine was normal, MRI of the pelvis with
MRA and MRV (TWIST) was normal. The MRI of the
lumbar spine showed the extruded disc L4-5 with
left foraminal occlusion and segmental stenosis.
Urine analysis and CXS was normal without
Decompressive left hemilaminectomy
foraminotomy left L4 and L5 roots. The extruded disk was removed
lateral to the axilla of left L5 root.
Left sided cleaning of L4-5 was performed. Using
MultiGen, bipolar motor stimulation of the L4
was achieved with 0.6 V and
L5 root was achieved with 1.1 V. A
bipolar pulsed mode
RF with 42 Celsius, 240 sec, 2 Hz and 20 msec
duration to left L4 and L5 roots was achieved using
4 bended catheters 10 mm exposed length. Further
motor stimulation done to the same roots and the
response was 0.6 V to the L4 and 0.8 V to the
left L5 root with more
brisk response. Routine closure of the
Smooth postoperative recovery. The power of
the left foot improved and she was sciatica free.
She 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 105th case using the BPRF mode
with MultiGen. This procedure regained routine acceptance.
It became a usual part of the spine and peripheral nerves
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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 there was considerable improvement of the threshold of
stimulation power of motor stimulation of L5, but the same
for L4 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.
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 anaesthesia
protocol also the same. In this case adhesions could be a
factor for initial high voltage requirement to achieve motor
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