The patient was operated by me 12-March-2008 for huge extruded disk L5-S1 with right downward migration. Subaxillary removal was performed at that time. The patient then came 21-October-2009 complaining of cramps of the leg and pain left hip and he was neurologically free and control MRI was asked, but he did not perform and disappeared. The patient then came to the clinic 26-July-2016  complaining of LBP for one month with right sciatica for 2 weeks. MRI lumbar spine performed 12-July-2016 showing recurrence of L5-S1 with right downward migration.

On examination: the patient is limping with exaggerated scoliotic stance. SLRS was 40 degrees with pain right side. There is weak dorsi and planterflexion right foot -4/5 with difficult setting.

The old incision was refreshed . Neurolysis right S1 was achieved. The extruded disk was removed lateral to the axilla from the right side and right sided cleaning of L5-S1 was performed. The subaxillary area was full of scar due to previous surgery. The depth of cleaning was 40 mm.  Using MultiGen, bipolar motor stimulation of right S1 root was achieved with 1.2 V. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to right S1 root was achieved using 2 bended catheters 10 mm exposed length. Further motor stimulation done to the same root and the response was 0.9 V in the right. Routine closure of the wound.

Smooth postoperative recovery. The power of right 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 72nd 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 considerable decrease of the threshold of stimulation power of motor stimulation after the procedure in the right side.

With accumulation of data, it became clear that the irritated nerve with aberrant currents running in the C fibers up, not only causing elevation of the motor stimulation, but they could cause the preoperative weakness. Ablation of such currents result in facilitation of the motor response and improvement of function with disappearance of pain.