The stenosis in this case is a progressive one and surgery will prevent further deterioration of her neurologic status. All the mobile and displaced segments must be reduced and stabilized.

This is the 212th case using the MultiGen for screw placement check. BPRF mode with MultiGen was not applied since the patient is not complaining of radicular pain.  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 BPRF was not used.

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.

The patient was operated by me 26-May-2007 for huge mass at the level of D7 causing to her practical paraplegia. The mass proved to be tbc granuloma and the patient recovered well. The patient then came several times, the pre-last time was 09-May-2015 complaining of neck pain, for what MRI neck preformed 10-May-2015 showing bulge disci and she was treated conservatively. The patient then came 22-March-22021 complaining of both legs pain  for 15 days  and unable to walk more then 5 meters. She had Corona virus 4.5 months ago and recovered. She is a known diabetic discovered at the first surgery, under treatment.

On examination: The patient in agonizing pain, walking with help, limping with exaggerated scoliotic stance. SLRS was 40 degrees with pain right side and 50 degrees in the left. There weak dorsiflexion right and left side -4/5. There is OA both knees without pain.

The patient was sent for investigations and MRI dorsal spine was normal, but there is severe lumbar canal stenosis L2-3, 3-4, 4-5 with spondylolisthesis L4-5 II degree. Cardio consultation was uneventful.

Skeletonization of the L2, 3, 4, 5 laminae down to the lateral processes. Using Nuvasive Armada surgical technique, transpedicular screw reduction and fixation of L3,4,5 was achieved using 6 screws polyaxial 6.5x45 mm length. All the screws did not respond to even 5 Volts stimulation. Wide decompressive laminectomy L3, L4, lower third of L2 and upper half of L5 with foraminotomy both L3. L4 and L5 roots.  Adjustable cross-connector was applied. The harvested bone was applied lateral to the rods. 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 feet improved. She was sent to the ward.