The patient came to the clinic 17-December-2016 complaining of LBP for 18 months with exacerbation of LBP and right sciatica for 3 months with numbness of all toes right foot the last 20 days. MRI lumbar spine bad quality performed showing huge extruded disc L5-S1 with right foraminal occlusion and downward migration. There is lumbarization of S1. The patient tried all alternative methods of treatment and failed.

On examination, the patient is limping now with exaggerated scoliotic stance. SLRS was 5 degrees in the right with severe pain and 60 degrees with pain in the left shooting to the right leg. There is weak right foot dorsiflexion -3/5, planterflexion same foot 4/5 with absent AJ in the right.

The patient was sent for new investigations and MRI lumbar spine performed 17-December-2016 showing huge extruded disc L5-S1 with right downward migration. ESR was 45 mm/h for what Zinnat was started to to resolve the unknown cause of infection.

Right L5 and S1 foraminotomy was achieved. The Level of the L5-S1 was identified because of lumbarization of S1. The extruded disk was removed lateral to the axilla under the S1 root. Right sided cleaning of L5-S1 was performed. Using MultiGen, bipolar motor stimulation of right S1 was achieved with 1.3 V. bipolar motor stimulation of right L5 was achieved with 0.5 V. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to the right :5 and S1 roots was achieved using 4 bended catheters 10 mm exposed length. Further motor stimulation done to the same roots and the response was 1.0 V in the right S1 with more brisk response and 0.4 V to the right L5 root. Routine closure of the wound.

Smooth postoperative recovery. The power of the right foot improved 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 98th 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 tell that the electrodes did not migrate during the procedure and the nerve is functioning properly. Here there was considerable improvement of the threshold of stimulation power of motor stimulation after the BPRF.

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 anaesthesia protocol also the same.