The patient came to the clinic 18-August-2015 from Qatar complaining of LBP and right sciatica for 8 years with exacerbation last 3 years.

On examination: the patient is not limping with no scoliotic stance. SLRS was 90 degrees both sides with pain in the right. There is weak dorsiflexion right foot 3/5 with hypalgesia right L5 territory.

The patient was sent for investigations and MRI of the lumbar spine performed 18-August-2015 showing extruded disc L4-5 with far downward migration with bulge L5-S1. Dynamic studies showed very minimal spondylolisthesis L4-5.

Using the C-arm, the level of L4-5 was identified. Right L5 foraminotomy was extended far and drilling of the right side of L5 lamina was done until the L5-S1 disc space and the right S1 axilla was under vision. Right side L4-5 discectomy was done and hard consistency fragments were subaxillary removed. The right L5 root is swollen and distorted. Circumferential inspection was done. All the compressive elements were eliminated. Using MultiGen parallel mode, pulsed RF ablation was applied to the right L5 root using the curved Stryker canula 10mmX 15 cm length 21 French gauge. The upper canula was located lateral to the axilla and the lower medial and below the dorsal ganglion. Pulsed mode was applied for 240 sec, 2 Hz with 42 Celsius. Inspection of the root after that showed no morphologic changes. Routine closure of the wound.

Smooth postoperative recovery. The power of the right foot became normal and no paraaneasthesia was noticed. The patient was sent to the ward.

Omar Pasha taking the ideas of Sluijter ME et al.,  using the epidural catheters in treating the neuropathic syndrome. In this case and to my knowledge will be the first case, these parameters were applied directly under vision to the exposed nerve.

Time and accumulation of the material will reflect the effectiveness of this maneuver.

The patient still have an estimated postoperative recurrence around 7%.