The patient came to the clinic 20-December-2016 complaining of LBP for 20 years with left sciatica for 2 months with numbness of all toes left foot. MRI lumbar spine performed 14-December-2016 showing huge extruded disc L4-5 with left foraminal occlusion and downward migration. The patient tried all alternative methods of treatment and failed.

On examination, the patient is limping now with exaggerated scoliotic stance. SLRS was 80 degrees with pain in the left. There is weak left foot dorsiflexion 3/5 with hypalgesia left L5, S1 territories.

Left L5 foraminotomy was achieved. The extruded disk was removed lateral to the axilla under the L5 root. Left sided cleaning of L4-5 was performed. Using MultiGen, bipolar motor stimulation of left L5 was achieved with 1.8 V. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to left L5 root was achieved using 2 bended catheters 10 mm exposed length. Further motor stimulation done to the same root and the response was 1.4 V in the left L5 with more brisk response. Routine closure of the wound.

Smooth postoperative recovery. The power of left foot improved and he was sciatica free. He 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 96th 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 tell 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 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.