The patient came to the clinic 30-December-2015 complaining of LBP with left sciatica down to the lateral aspect of the left ankle for 3 months. MRI lumbar spine done 01-October-2015 showing bulge L5-S1 central more to the left. The patient was in conservative treatment with physiotherapy. The patient deteriorated more and came with agonizing left sciatica.

On examination: the patient is in agonizing pain. She is limping with exaggerated scoliotic stance. There is weak dorsiflexion left foot 4/5. Positive cough sign. SLRS was 90 degrees both sides with pain in the left SIJ.

The patient was sent for new investigations and MRI lumbar spine performed 02-January-2016 showing extruded disc L5-S1 with left foraminal occlusion. MRI of the pelvis was uneventful. Dynamic studies ruled out the presence of overmobility.

Left L5-S1 hemiflavotomy with foraminotomy left S1 root. The extruded disc was removed lateral to the axilla and left sided intradiscal cleaning of L5-S1 was achieved.  Using MultiGen, a pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to the left S1 root was achieved.   Routine closure of the wound.

Smooth postoperative recovery. The power of left foot became normal. The patient still complaining of the same sciatica as before surgery. She was sent to the ward for observation.

The patient still has an estimated postoperative recurrence around 7%, because the disc space still not completely shallow.

This is the 23rd case using the PRF mode with MultiGen. This procedure regained routine acceptance  it will be a usual part of the spine surgery. Click here for reference. In his case it seems that the procedure was not effective.