The patient came to the clinic 14-February-2007 complaining of LBP for 10 years with right sciatica for 2 days not reaching below the right knee. MRI lumbar spine performed at that time showed bulge diski L1-2, 2-3, 3-4 with dehydration of L4-5. The patient was treated conservatively. The patient then came 19-June-2012 complaining of LBP with right sciatica for 10 days. MRI done 21-June-2012 showing the same previous data and was treated conservatively. The patient then came 07-April-2016 complaining of LBP with right sciatica for 3 weeks. The patient at this time is limping with exaggerated scoliotic stance with weak dorsiflexion right foot -4/5. SLRS was 70 degrees left side shooting to the right leg. MRI lumbar performed 30-April-2016 showing extruded disk L3-4 with left downward migration. The patient told me that he improved with pain killers, for what he was told to continue in conservative treatment. The patient then came  13-August-2016 complaining of agonizing left sciatica for 5 days.

On examination: the patient is not limping with exaggerated scoliotic stance. SLRS was 80 degrees without pain. There is weak dorsiflexion left foot -4/5 with difficult setting.

The patient was sent for investigations and MRI lumbar spine performed 14-August-2016 showing further enlargement of the extruded disk L3-4 with far left downward migration. Dynamic studies and lab investigations  were uneventful.

Using the C-arm, the L3-4 level was identified and decompressive laminectomy L3 and L4 was done. Foraminotomy both L4 roots was achieved. The extruded disk was removed subaxillary from left side and left sided cleaning of L3-4 was performed. Using MultiGen, bipolar motor stimulation of right L4 root was achieved with 1.0 V. The left L4 root was achieved with 1.1 V. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to the both L4 roots was achieved using 4 bended catheters 10 mm exposed length. Further motor stimulation done to the same roots and the response was 0.8 V to the right and 0.9 V to the left. Routine closure of the wound.

Smooth postoperative recovery. The power of left foot 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 71st 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 slight decrease of the threshold of stimulation power of motor stimulation after the procedure in the root.

It seems that irritation of the nerve with pain generation is the result of chaotic currents coming up and down all the time through the non-myelinated fibers. For that before applying the BPRF is the threshold for motor stimulation is higher than after the procedure.