The patient came to the clinic 06-August-2017 complaining of LBP for 6 years with intermittent course with right sciatica for 2 month. MRI lumbar spine performed 17-July-2017 showing extruded disc L5-S1 central more to the left.

On examination, the patient is not limping with exaggerated  scoliotic stance. SLRS was 80 degrees with pain in the right. There is weak dorsiflexion both feet 4/5.

The patient was sent for investigations and MRI lumbar spine performed 06-August-2017 showing huge extrusion L5-S1 with right soft part and left solid part. Dynamic studies ruled out overmobility and Lab investigations showed uric acid 9.1 mg/L.

Bilateral foraminotomy of both S1 roots was achieved. The extruded disk was removed subaxillary from left side. Left sided intradiscal cleaning of L5-S1 disc space was performed. It was possible to remove the all the extrusion from the left side. Inspection of the right S1 root and the annulus fibrosis right side was uneventful. Using MultiGen, bipolar motor stimulation of the right S1 was achieved with 0.7 V, bipolar motor stimulation of the left S1 was achieved with 1.0 V. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to both S1 roots was achieved using 4 bended catheters 10 mm exposed length. Further bipolar motor stimulation of the right S1 was achieved with 0.7 V, bipolar motor stimulation of the left S1 was achieved with 1.0 V. 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 having an estimated postoperative recurrence around 7%, because the disc space is still not shallow.

This is the 129th 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 the threshold of stimulation power of motor stimulation of the roots after application the same.

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 in most cases.