The patient came to the clinic 09-March-2021 complaining of LBP with right sciatica for one month.

On examination: The patient is in agonizing pain, limping with exaggerated scoliotic stance. There is weak dorsiflexion right foot -4/5. SLRS was 70 degrees with pain both sides. The right KJ is absent.

The patient was sent for investigations and MRI done 09-March-2021 showing huge extruded disc L2-3 central more to the right.

Extended bilateral L3 foraminotomy with removal of the extrusion from both sides and bilateral intradiscal cleaning of L2-3, after what the roots became relax. There was  a tiny CSF leak from the right upper corner of the field, but there is no proper seen dural defect. A piece of muscle was applied to that area. Using MultiGen, bipolar motor stimulation of the right L3 root was achieved with 0.5 Volts, bipolar motor stimulation of the left L3 root was achieved with 1.5 Volts. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to both L3 roots  was achieved using 4 bended catheters 10 mm exposed length. Further bipolar motor stimulation of the right L3 root was achieved with 0.5 Volts, bipolar motor stimulation of the left L3 root was achieved with 1.2 Volts. The patient was put in Reverse Trendelenburg position with Valsalva maneuver and hyperventilation. No CSF leak. Routine closure of the wound.

Smooth postoperative recovery. The power of the right foot still the same. He was sent to the ward.

There is still an estimated postoperative disc recurrence around 7%, since the disc space is not completely shallow.

This is the 211th 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 motor stimulation of the affected nerves did not change dramatically after 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 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.

After the 172d case, the elevation of motor stimulation above 5 V was abandoned to avoid delayed dural tear with subsequent CSF leak, which take place at the contact at the lower electrode shaft with the dura below the level of the axilla.