The patient came to the clinic 14-February-2018 complaining of LBP with right sciatica for 2 weeks down to the right lateral malleolus. She is using walker for 2 days. She is a known diabetic, with arterial hypertension in L-thyroxin 50 microgram for 4 years.

On examination, the patient is in agonizing pain, limping with scoliotic stance. SLRS was 30 degrees in the right with pain and 50 degrees in the left with pain shooting to the right leg. There was drop right foot -0/5, planterflexion same foot 5/5. The right AJ is absent.

The patient was sent for investigations and cardio consultation and MRI lumbar spine done 14-February-2018 showing huge extruded disc L4-5 with right foraminal occlusion. Dynamic studies were negative for overmobility.

Foraminotomy of the right L5 root was achieved. The extruded disk was removed lateral to the axilla from right side. Right sided intradiscal cleaning of L4-5 disc space was performed. Subaxillary inspection revealed a huge fragment migrating downward. It was removed, For the future project, an hexagonal Allen key No 8 was with difficulty going inside the annulus fibrosis defect. Using MultiGen, bipolar motor stimulation of the right L4 root was achieved with 0.9V. The L5 root was achieved with 1.3 V with planterflexion response. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to the right L4 and L5 roots was achieved using 2 bended catheters 10 mm exposed length. Further bipolar motor stimulation of the right L4 root was achieved with 0.7V. The L5 was achieved with 1.2 V. Routine closure of the wound.

Smooth postoperative recovery. The power of the right foot became better and she can dorsiflex the big toe. 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 144th 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 stimulation power of motor stimulation of the root after application was better.

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.

Drop foot  can benefit from such BPRF, if the the duration f the pathology is not long-standing.