The patient came to the clinic 07-March-2017 complaining of LBP with left sciatica for 2 months with numbness all toes left foot. The patient is a known diabetic for 2 years under treatment.

On examination, the patient is limping with exaggerated scoliotic stance. SLRS was 30 degrees left side with pain. There is weak dorsiflexion left foot 3/5.

he patient was sent for investigations and MRI lumbar spine performed showing extruded disc L5-S1 with left foraminal occlusion. The patient was sent for cardiac evaluation.

Foraminotomy left S1 root. The extruded disk was removed lateral to the axilla of the left S1 root. The extruded downward migration was also removed. Left sided cleaning of L5-S1 disc space was performed. Using MultiGen, bipolar motor stimulation of the left S1 was achieved with 0,7 V. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to left S1 root was achieved using 2 bended catheters 10 mm exposed length. Further bipolar motor stimulation of the left S1 was achieved with 0.7 V with more vivid response. Routine closure of the wound.

Smooth postoperative recovery. The power of left foot normalized and she was sciatica free. She was sent to the ward.

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

This is the 111th case using the BPRF mode with MultiGen. This procedure regained routine acceptance.  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 there was some improvement of the threshold of stimulation power of motor stimulation of the left S1.

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.

The patient was operated by me 15-March-2017 and the last day got agonizing left sciatica for what urgent MRI and Lab test were performed 23-March-2017. MRI showed recurrent disc L5-S1 with left foraminal occlusion.

On examination, the patient is in agonizing sciatica left side and walking with difficulty. There is no neurologic deficit. The patient was taken immediately to the operating room.

Revision of the wound with exposure of the left S1 root. The extruded disk was removed lateral to the axilla of the left S1 root. Inspection of the subaxillary area was performed. Left sided cleaning of L5-S1 disc space was performed. Routine closure of the wound.

Smooth postoperative recovery. The sciatica disappeared. She was sent to the ward.

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

The previously used MultiGen did not help when gross anatomical compression was applied to the root. It seems that, the pain transmission take over other fibers, beside the C- and unmyelinated fibers, as in this case.