The patient came to the clinic 31-August-2016 complaining of LBP with right sciatica for 17 days down to all toes right foot.

On examination, the patient was limping with exaggerated scoliotic stance. SLRS was 80 degrees with little pain in the right. There is drop right foot with hypalgesia right L5 and S1 roots territories.

The patient was sent for neurophysiologic investigations and MRI lumbar spine performed the same day showing huge extruded disc L4-5 with right downward migration and old stable spondylolisthesis L5-S1. Dynamic studies ruled out overmobility of L5-S1 segment. ESR was 35 mm/h.

Right hemilaminectomy L5 and lower third of L4 was achieved. During this the posterior arch of the L5 lamina was mobile. All efforts were paid so as not to increase the instability. Foraminotomy right L5 and S1 was achieved. The extruded disk was removed subaxillary under the L5 root, which was pushed lateral. Right sided cleaning of L4-5 was performed. The depth of cleaning was 40 mm.  Using MultiGen, bipolar motor stimulation of right L5 was achieved with 1.0 V, S1 root was achieved with 0.6 V. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to right L5 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 0.6 V in the right L5 and S1 roots with more brisk response. Platelet-rich plasma extract was obtain by withdrawing 20 ml blood centrifuged and 4.5 ml of PRP volume was achieved and irrigated around both roots in hope to promote recovery of the drop foot. Routine closure of the wound.

Smooth postoperative recovery. The power of right foot dramatically improved and she was sciatica free. She 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 75th 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 no change of the threshold of stimulation power of motor stimulation after the procedure in the right S1 root, but the right L5 root became functionally better before application of PRP.

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.

PRP: platelet-rich plasma is a proven procedure to improve the cartilage regeneration and used in orthopedic surgery for many years. We hope it will promote recovery of the involved roots, resolving the problem with the drop foot. Time will give the answer. This is the first trail in drop foot case and we will repeat this procedure in all future drop feet cases to properly evaluate its effectiveness.