The patient came to the clinic 29-February-2016 complaining of LBP for 2 years. MRI lumbar spine done 11-January-2014 showing bulge L4-5. 1 month ago got left sciatica down to big toe left foot with numbness. MRI done bad quality at KHMC yesterday showing extruded disc L4-5. The patient is hypertensive in medication for 7 years.

On examination: the patient is not limping with exaggerated scoliotic stance. SLRS was 60 degrees with pain in the left. There is weak dorsiflexion left foot -4/5 with hypalgesia left L5 territory.

The patient was sent for MRI lumbar spine, dynamic studies and Lab investigations. It was preformed 01-March-2016 showing extruded disc L4-5 with left extraforaminal and upward migration. Dynamic studies ruled out overmobility. The patient was advised to stop anticoagulants for at least 5 days before surgery.

The level of L4-5 was identified and left L4 partial hemilaminectomy was performed and foraminotomy left L4, L5 roots was achieved. The extrude disc was removed and left sided intradiscal cleaning of L4-5 was achieved. The left L4 root was brought under vision to rule out any remnant of the extrusion. One big fragment was removed from under the extraforaminal course of the left L4 root.  Using MultiGen, a bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to left L4 and L5 roots was achieved using 4 bended catheters 10 mm exposed length. Routine closure of the wound.

Smooth postoperative recovery. The power of left foot became normal. The patient is sciatica free. He was sent to the ward.

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

This is the 42nd 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.