The patient was operated was operated by me for extruded disk C6-7 30-August-2008. The patient then came 22-August-2016 complaining of severe neck and headache for 5 months with left upper limb pain and episodes four limbs pain with numbness. MRI cervical spine performed 18-August-2016 showing huge extruded disk C3-4.

On examination: the patient has pain when turning the neck to all directions. There is hypalgesia below C3 down to C7 both sides. There is weak both deltoids and biceps 4/5. Flexion and extension of both hands 3/5. Both triceps -4/5. SLRS was 40 degrees both sides with pain.  Weak dorsiflexion both feet -4/5 and planterflexion right foot -4/5.

The patient was sent for new investigations and MRI of the brain was normal but the spinal cord was severely compressed by the extruded disk C3-4.

New projectional incision was created because the old one is not suitable to the new level. Diskectomy C3-4 was performed and the extruded disk was removed until the dura was seen at the posterior projection. The epidural vein from the left side was severely bleeding and it took 30 min to completely control it.   Using MultiGen, bipolar motor stimulation of the right C4 root was achieved with 0.7 V. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to right C4 root was achieved using 2 bended catheters 5 mm exposed length. Further motor stimulation done to the same root and the response was 0.9 V in the left. The motor stimulation was increased up to 3 V and it was noticed that both upper limbs and the abdominal muscles were responding. A cervical cage 5x12x15 was inserted and ACP 18 mm length with four screws 4x14 mm were used to fused C3-4. All stages of surgery were performed with C-arm guidance. Routine closure of the wound.

Smooth postoperative recovery. The power of four limbs normalized and she was sent to the ward.

The recurrence rate in cervical disk surgery is zero.

This is the 74th 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 increase of the threshold of stimulation power of motor stimulation after the procedure in the right side.

In comparison to the lower spine the ILLICO system failed to be used.

The catheters were used with less precision as compared with the lumbar area and the bending of the tips was needed to be bended more to reach the target.