The patient came to the clinic 04-March-2006 complaining of LBP for 1 year with left sciatica with numbness left L5 territory. The patient was sent for investigation and MRI lumbar spine done 07-March-2006 showing extruded disc L5-S1 with left downward migration. The patient was advised to undergo surgery, but he escaped. The patient then came 10-May-2021 with right sciatica for 45 days, then bilateral for 30 days. MRI done today showing severe stenosis L3-4, L4-5 with huge extrusion L4-5 central more to the left. The old extrusion of L5-S1 regressed.

On examination: the patient in agonizing pain, limping with exaggerated scoliotic stance. SLRS was 60 degrees with pain right side and 40 degrees with more pain in the left. There is weak dorsiflexion both feet 4/5 and planterflexion left foot 4/5.

Decompressive laminectomy L4, lower third of L3 and upper third of L5. The bone was marble hard that we used several drills to perform the bony part. Foraminotomy both L5 roots. The extruded disc was attacked first from the left, then bilateral cleaning L4-5 was achieved.  Using MultiGen, bipolar motor stimulation of the right L5 root was achieved with 1.4 Volts, bipolar motor stimulation of the left L4 root was achieved with 0.8 Volts. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to both L5 roots  was achieved using 4 bended catheters 10 mm exposed length. Further bipolar motor stimulation of the right L5 root was achieved with 0.7 Volts, bipolar motor stimulation of the left L5 root was achieved with 0.6 Volts. The patient was put in Reverse Trendelenburg position with Valsalva maneuver and hyperventilation. No CSF leak. Routine closure of the wound

Smooth postoperative recovery. The radicular pain decreased and the power of both feet normalized. He was sent to the ward.

The recurrence rate in this case still ranking around 7% because the disc space is not completely collapsed.

This is the 213th case using the MultiGen. BPRF mode with MultiGen was applied since the patient is complaining of radicular pain.  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 BPRF was used and motor stimulation considerably improved after it.

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 minute session in most cases.

After the 172d case, the elevation of motor stimulation above 5 V was abandoned to avoid delayed dural tear with subsequent CSF leak, which take place at the contact at the lower electrode shaft with the dura below the level of the axilla.