The patient came to the clinic 22-March-2017 complaining of neck, right upper limb pain and numbness right hand for 45 days and numbness right foot the last 2 days with cephalgia. MRI cervical spine performed 11-March-2017 showing huge extruded disc C5-6 central with right foraminal occlusion.  The patient in Concor 2.5 mg once daily for 5 years.

On examination, the patient is in agonizing pain. He has pain when turning the head to the left, up, down, and when bending the head to both shoulders, more to the left. There is weak flexion, extension right hand -4/5 and right triceps 3/5. There is also weak dorsiflexion right foot 4/5.

he patient was sent for cardiac evaluation.

Through anterior approach, discectomy C5-6 was performed with removal of the extrusion until the dura was seen all over the posterior edges of C5 and C6.  Using MultiGen, bipolar motor stimulation of the right C6 root  was achieved within the disc space with 2.2 V. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to right C6 root was achieved using 2 bended catheters 10 mm exposed length. Further bipolar motor stimulation of the right C6 was achieved with 2.0 V with more vivid response. Solis cage 6x12 mm with Vitos bone graft (TCP) were inserted to disc space. One level Reflex Hybrid Stryker ACP 16 mm length was used with 4 screws 16x4 mm were used to fuse C5-6. Routine closure of the wound. All stages of surgery were C-arm guided.

Smooth postoperative recovery. The power of the right upper limb normalized. He was sent to the ward.

The recurrence rate in cervical disc surgery is zero.

This is the 113th 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 there was slight improvement of the threshold of stimulation power of motor stimulation of the right C6 root.

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 4-5 minutes session.