The patient was transferred from Arabic Center with agonizing LBP. Pain management for 12 days failed to improve her and she is bedridden with Foley's catheter. The LBP was for 24 years with exacerbation last 2 months. The patient is a known diabetic with arterial hypertension.

On examination, the patient was in bed and difficult to examine due to agonizing pain.  SLRS was 20 degrees with pain in both sides. There is weak dorsiflexion both feet -3/5.

The patient was sent for investigation and MRI of the lumbar spine showed severe stenosis L4-5 and to lesser degree of L3-4 with extruded disc L4-5. MRI of the pelvis was unremarkable. Dynamic studies showed hint of overmobility of L4-5.

Skeletonization of L3-4-5. Check of overmobility was positive for L4-5. Transpedicular fixation of L4-5 using Legacy system with 2 monoaxial screws 6.5x50 to L5 and 2 screws 6.5x45 mm to L4. Decompressive laminectomy L4 and upper half of L5. The residual epidural fat was blue due to previous injections. Foraminotomy both L5 roots. The disk L4-5 was inspected both sides. It was decided not to violate it.  The screws were not responding even to 10 V. There was a tear of the left L5 root which was repaired by 6 zero nylon. Using MultiGen, bipolar motor stimulation of left L5 was achieved with 1.8 V. The right L5 root was responding to 1.5 V. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to both L5 root was achieved using 4 bended catheters 10 mm exposed length. Further motor stimulation done to the same roots and the response was 1.6 V in the left L5 with more brisk response and 1.5 V to the right L5 root. The same procedure was performed to Both L4 roots and the response before after ablation was 1.0 V. The harvested bone was applied lateral to the rods. Routine closure of the wound.

Smooth postoperative recovery. The power of both feet still the same. She was sent to the ward.

The patient has severe lumbar canal stenosis, that cannot explain the agonizing pain. The segmental overmobility is the determinant factor for pain generation, which needs correction.

This is the 84th 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 change 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.