The patient was operated by me 11-June-2016 for right sciatica and spondylolisthesis of L3-4 and scoliotic deformity of Lumbar spine with Cobs angle 20 degrees at L2. The patient came several times with the weak right quadriceps muscle with agonizing right sciatica. He was sent to perform CT-scan of the lumbar area, which was done 05-September-2016 revealing that the right L4 screw is shifted medially. The other screws were acceptable.

On examination, the patient still in agonizing right sciatica, limping with exaggerated scoliotic stance. SLRS was zero degrees with pain in right side. There is weak right quadriceps muscle 2/5 and adductor group of muscles 3/5. The dorsi and planterflexion of the right foot is 5/5. It was decided to remove the shifted medially screw and foraminotomy of the right L2,3,4,5 roots to see what is going on.

Exposure of the construct and the right rod was removed to allow removal of the right L4 body screw. Resection of the isthmus over the right L2,3,4 roots to obtain complete decompression of the roots. The removed screw was not causing harm and the cause of the condition retrospectively was due to distraction of the left side of the spine, causing slight compression of the right roots. Using MultiGen, bipolar motor stimulation of right L2 was achieved with 5.0 V, right L3 root was achieved with 3.0 V and the right L4 root with 6.0 V. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to right L2,3,4 roots was achieved using 2 bended catheters 10 mm exposed length. Further motor stimulation done to the same roots and the response was 3.5 V in the right L2, 3.0 V in the right L3 and 5.0 V in the right L4 root with more brisk response. The rod was put back with the cross connector. PRP 4.5 ml was applied to the roots. Routine closure of the wound.

Smooth postoperative recovery. The power of adductor group of muscles improved. He was sent to the ward.

The patient has an agonizing right sciatica with a lot of problems. which needs answer. Revision of the whole right area was a must.

This is the 78th 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.

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 decrease of the threshold of stimulation power of motor stimulation after the procedure in all  roots.

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.

The roots were responding to high volts, which means they are functioning but severely damaged due to compression. 2 roots improved the response after the BPRF.