The patient came to the clinic 27-July-2016 complaining of LBP for 7 years after RTA. He felt down 5 months ago after what he got exacerbation of LBP with bilateral sciatica more the left  with more exacerbation the last 2 days. MRI lumbar spine performed 02-December-2016 showing extruded disk L4-5 central more to the left.

On examination: the patient is limping with exaggerated scoliotic stance. SLRS was 7 degrees right side and 5 degrees left side with pain. There is weak dorsiflexion both feet 3/4.

The patient was sent for investigations and MRI lumbar spine performed 27-July-2016 showing enlargement of the previous extrusion. Dynamic studies and lab investigations were normal.

Using the C-arm, the L4-5 level was identified and decompressive laminectomy L4 and L5 was done. Foraminotomy both L5 root was achieved. The extruded disk was removed from left side and bilateral cleaning of L4-5 was performed. Using MultiGen, bipolar motor stimulation of both L5 roots was achieved with 1.2 V in the right root and 0.6 V in the left. 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. During this ablation process the left L5 root had all the time motor response. Further motor stimulation done to the same roots and the response was 0.9 V in the right and 0.5 V in the left. Routine closure of the wound.

Smooth postoperative recovery. The power of both feet normalized and he was sciatica free. 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 68th 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.

This is the first case that BPRF was triggering the motor response to the root. It could be that the nerve was very irritated that it was sensitive to very low stimulation.