The patient came to the clinic 12-June-2016 complaining of LBP and right sciatica for 10 days with difficult standing in chair and numbness of the big toe right foot. MRI lumbar spine performed 12-June-2016 showing huge extruded disc L5-S1 with with right foraminal occlusion and downward migration.

On examination: the patient is now not limping with no scoliotic stance. SLRS was 30 degrees right side with pain. There is weak dorsiflexion right foot 4/5 and hypalgesia right L5 and S1 territories. Absent right AJ.

Using the C-arm, the L5-S1 level was identified and foraminotomy right S1 root was achieved with preservation and reflection of the ligamentum flavum to the left trying to keep the epidural fat. The extruded disk was removed from right side and right sided cleaning of L5-S1 was performed. The extruded disc material was hard in consistency.  Using MultiGen, bipolar motor stimulation of right S1 root was achieved with 1.4 V. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to right S1 roots 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. Routine closure of the wound.

Smooth postoperative recovery. The patient is sciatica free. The power of right foot normalized and he was sent to the ward.

The patient still have an estimated postoperative recurrence around 7%, because the disc space is still not shallow.

This is the 66th 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 no difference of power of motor stimulation before and after the procedure.