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 bacterial growth.

Decompressive left hemilaminectomy of L4,  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 wound.

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 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 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 response.