The patient was operated by me 04-May-1999 for huge extruded disc L5-S1 with left foraminal occlusion. The patient then came to the clinic 22-July-2004 with clinical picture of recurrent extrusion with left downward migration  seen at MRI performed 17-June-2004 and she was advised to undergo surgery, but she escaped. The patient then came 13-February-2016 telling that she was OK until the last three days had episode of renal colic due to stone kidney, which resolved by passage of the stone, but after then got agonizing LBP with left sciatica with numbness all toes left foot. MRI investigations were performed at Al-Kerak hospital 11-February-2016 which missed the level of L5-S1 from the study.

On examination: the patient is in agonizing pain, unable to evaluate limping nor scoliotic stance. SLRS was 35 degrees in the left with pain. There is weak dorsiflexion left foot 2/5 and planterflexion left foot 3/5. Analgesia of the left S1 territory with hypalgesia L5.

The patient was sent for investigations and MRI done the same day showing a bulge of L4-5 and recurrent disc L5-S1 with left downward migration. Dynamic studies ruled out overmobility. The patient is diabetic for 1 year and hypertensive. She was sent for cardio consultation. Upon examination before surgery the patient had flail foot with complete drop left foot.

Neurolysis of the left S1 root with removal of the extrusion with further intradiscal cleaning of L5-S1 disc space from the left. Using MultiGen, a bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to the left S1 and and percutaneously the S2 roots  was achieved using 4 bended catheters 10 mm exposed length. Using C-arm the left L5 root was reached by 2 catheters and stimulation showed good response of dorsiflexion. It was also included in the above mentioned application. Routine closure of the wound.

Smooth postoperative recovery. The power of left foot became better. The patient is sciatica free. He was sent to the ward.

The patient have an estimated postoperative recurrence around 0%.

This is the 34th 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.

This case is demonstration to pain management beyond the operative site. The S1 and L5 roots were reached percutaneously.