The patient came to the clinic 22-February-2016 complaining of LBP with left sciatica for 10 years with exacerbation last 2 months with sciatica down to the heel of the left foot. She use crutches for 2 years. MRI lumbar spine done 19-January-2016 showing severe stenosis L3-4 and L4-5. Left knee MRI showing synovitis with torn menisci. She is diabetic for 10 years, hypertensive for 2 years under treatment.

On examination: the patient is limping with exaggerated scoliotic stance. SLRS was 70 degrees with pain left side. There is weak dorsiflexion right foot 4/5, left foot 3/5, weak planterflexion left foot 4/5 and hypalgesia left L5 and S1 territories.

The patient was sent for MRI lumbar spine. It was preformed the same day showing spondylolisthesis L3-4, L4-5 with severe segmental stenosis. Dynamic studies confirming this. She was sent for cardio consultation and stopped Baby aspirin for 5 days.

Skeletonization of L3, L4 and L5. Using XIA 3 system 6 transpedicular monoaxial screws 6.5x45 mm  inserted to L3, L4 and L5 bodies. Decompressive laminectomy L3,4 and upper half of L5. Foraminotomy both L4 and L5 roots was achieved. Cross connector MAC 42 mm applied with the harvested bone milled and applied lateral to the rods. MultiGen, a bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to both L4 and  L5 roots was achieved using 4 bended catheters 10 mm exposed length. Routine closure of the wound.

Smooth postoperative recovery. The power of both feet became normal. The patient is sciatica free. She was sent to the ward.

The patient has progressing spondylolisthesis with overmobility, that surgical stabilization left to be the only solution.

This is the 40th 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.