The patient came to the clinic 02-July-2023 complaining of intermittent claudication and inability to walk more than 10 min. The condition started 1 year ago and deteriorating. Known diabetic for 3 years in Glucophage 500 mg twice daily not regular. Has enlarged prostate in medication.

On examination, the patient walking bended anterior with scoliotic stance. SLRS was 80 degrees both sides. There is weak dorsiflexion both feet 4/5.

The patient was sent for investigations and MRI lumbar spine done 03-July-2023 bad quality, but showing severe LCS L4-5. Dynamic studies done showing ankylozing of D12 down to L5 with no overmobility.

Decompressive laminectomy L4 lower 3/4 of L3 and upper third of L5 with foraminotomy both L5 roots with inspection of the annulus fibrosis of L4-5. It was decided not to violate the disc because there is no extrusion. Using MultiGen, bipolar stimulation of the right L5 root was responding 2.8 Volts, bipolar stimulation of the left L5 root was responding to 1.4 Volts. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to both L5 roots  was achieved using 4 bended catheters 10 mm exposed length. Further bipolar stimulation of the right L5 root was responding to 2.5 Volts, bipolar stimulation of the left L5 root was responding to 1.0 Volts. The patient was put in Reverse Trendelenburg position with Valsalva maneuver and hyperventilation. No CSF leak. The power of the feet normalized. He was sent to the ward.

Too early now.

The patient has progressive severe LCS. The sooner the decompression the better the outcome.

This is the 261st case using the MultiGen. This procedure regained routine acceptance.  It became a usual part of the spine and peripheral nerves surgery. Click here for reference. The patient showed considerable improvement of the motor stimulation after BPRF.

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 was the same and the anesthesia protocol also the same.

It could be that the nerve is recovering minute by minute after decompression and this can explain why the motor conductivity is improving after the BPRF application, which require 5 minute session in most cases.

After the 172d case, the elevation of motor stimulation above 5 V was abandoned to avoid delayed dural tear with subsequent CSF leak, which take place at the contact at the lower electrode shaft with the dura below or above the level of the axilla.

Before doing motor stimulation in peripheral nerve surgery with tourniquet. always remove the tourniquet before performing motor stimulation.