Inomed Stockert Neuro N50. A versatile
RF lesion generator and stimulator for
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Multigen RF lesion generator .
14-FEBRUARY-2017 MUSA MUHAMED MUSA 73 YEARS
HUGE EXTRUDED DISC L4-5 WITH RIGHT UPWARD MIGRATION.
Anamnesis
The patient was operated by me 08-July-2000 for
PCD C5-6, c6-7 with fusion of C5-6-7 and was
doing well. The patient then came to the clinic
01-February-2017
complaining of LBP for 1 day with bilateral
sciatica. The patient has diabetes
mellitus for 1 years and had stinting 21 years
ago.
On examination, the patient is limping with exaggerated scoliotic stance. SLRS
was 10 degrees right side with pain and 5
degrees in the left with more pain. There is weak
both feet dorsiflexion 4/5 and planterflexion
both feet 4/5. There is pain both hips and SIJs.
The patient was sent for investigations: MRI
of the pelvis was normal, The MRI of the
lumbar spine showed the extruded disc L4-5 with
right right upward migration and segmental
stenosis. Dynamic studies showed minimal
spondylolisthesis L4-5. ESR was 35 mm/h and CRP
was 8 mg/L. he patient was sent for cardio
evaluation and Zinnat started 500 mg twice
daily.
Decompressive laminectomy
of L4 and upper part of L5 was done,
foraminotomy both L4 and L5 roots both sides. The extruded disk was removed
lateral to the axilla of the right L5 root
extending far up.
Right sided cleaning of L4-5 was performed.
Inspection of the annulus fibrosis from the left
side was uneventful. Using
MultiGen, bipolar motor stimulation of the right L4
was achieved with 1.1 V and the left side
with 0.9 V. The right
L5 root was achieved with 1.6 V and the left one
with 2.0 V. A
bipolar pulsed mode
RF with 42 Celsius, 240 sec, 2 Hz and 20 msec
duration to both L4 and L5 roots both sides was achieved using
4 bended catheters 10 mm exposed length. Further
bipolar motor stimulation of the right L4
was achieved with 0.9 V and the left side
with 0.9 V. The right
L5 root was achieved with 1.6 V and the left one
with 2.2 V with more
brisk response. 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.
MultiGen
Comments
The patient still having an estimated
postoperative recurrence around 7%, because the disc
space is still not shallow.
The minimal spondylolisthesis was ignored
in relation to the big extrusion at the same level.
This is the 107th 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 there was the same threshold of
stimulation power of motor stimulation of the right L5, but the same
for left L4 after the BPRF. The decrease of the motor
response of the left L5 root could be explained by some
shift of the electrodes?
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.
Diabetes Mellitus and old age in this
case are the reason for relatively high voltage to regain
motor response.
Skyra MRI with all clinical applications in the run since 28-Novemeber-2013.
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Inomed MER system
Leica HM500
The World's first and the only Headmounted Microscope.
Freedom combined with Outstanding Vision, but very bad video recording and
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After long years TRUMPF TruSystem 7500 is running with in the neurosuite at
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Notice: Not all operative activities
can be recorded due to lack of time.
Notice: Head injuries and very urgent surgeries are also
escaped from the plan .