The patient was operated by me 22-August-2015 for huge extruded disc L4-5 and was doing fine. The patient then came to the clinic 23-May-2016 complaining of LBP for one month and right sciatica for 4 days.

On examination: the patient is limping with exaggerated scoliotic stance. SLRS was 80 degrees right side with pain. There is no weakness neither sensory deficit.

The patient was sent for investigations and MRI lumbar spine performed 23-May-2016 showing huge recurrence of L4-5 with right downward migration. Dynamic studies ruled out overmobility. ESR was 30 mm/h.

Using the C-arm,  neurolysis of the right L5 root was achieved. It was stuck to the bone and the subaxillary extrusion was severely compressing it lateral, for what it suffered minor damage during dissection. The extruded disk was removed from right side subaxillary and right sided cleaning of L4-5 was achieved. Using MultiGen, stimulation of right L5 nerve was achieved with 1.8 V. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to the right L5 root was achieved using 2 bended catheters 10 mm exposed length. Further motor stimulation done to the same root and the same response was noted. Routine closure of the wound.

Smooth postoperative recovery. The patient is sciatica free. The patient was sent to the ward.

The patient still have an estimated postoperative re-recurrence around 7%, because the disc space is still not shallow.

This is the 58th 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.

The patient was the first case, to whom BPRF was applied. It seems that the BPRF is temporary in effect and wearing off after several months.