The patient came to the clinic 13-August-2016 complaining of LBP for 2 years with bilateral sciatica more to the left for 5 months with radiation to posterior aspect of the left thigh.

On examination: the patient is not limping with no 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 13-August-2016 showing huge extruded central disk L4-5 more to the left. Dynamic studies and lab investigations  were uneventful.

The L4-5 level was identified and decompressive laminectomy L4 and L5 was done. Foraminotomy both L5 roots was achieved. The extruded disk was removed from left side and left sided cleaning of L4-5 was performed. The other side was inspected and not violated. Using MultiGen, bipolar motor stimulation of right L5 root was achieved with 1.5 V in the right root and 0.9 V in the left root. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to both L5 roots was achieved using 4 bended catheters 10 mm exposed length. Further motor stimulation done to the same roots and the response was 1.3 V in 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 70th 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 right side and without changes in the left.