The recurrence rate in this case still ranking around 7% because the disc space is not completely collapsed.

This is the 214th case using the MultiGen. BPRF mode with MultiGen was applied since the patient is complaining of radicular pain.  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 BPRF was used and motor stimulation mildly improved after it.

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 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 4 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 the level of the axilla.

The patient came to the clinic 16-May-2021 complaining of LBP with right sciatica for 16 days. MRI done 03-May-2021 bad quality showing bulge L3-4 and L5-S1 with an old mass at S2 which is present for 20 years.

On examination: the patient in pain, limping with exaggerated scoliotic stance. SLRS was 70 degrees with pain right side. No motor or sensory deficit.

The patient then came to the emergency of Shmaisani hospital wit very severe LBP and right sciatica with inability to walk for several hours in the morning of 20-May-2021 with weak dorsiflexion right foot 4/5 and the pain shooting to the right knee, for what repeat MRI of the spine and the pelvis. After several intended protocols which are directed to explain the proper source of his agonizing sciatica, it was found that there is an extraforaminal-foraminal extrusion of L3-4 severely compressing the running root.

Foraminotomy right L3 root. The extruded disc was attacked from the right and right sided cleaning of L3-4 was done.  The foramen was widened so as to explore the area without violating the integrity of the isthmus and lateral mass. Inspecting the above running right L3 root showed that it severely compressed by far upward migrating extraforaminal huge piece which was removed in one piece. Using MultiGen, bipolar motor stimulation of the right L3 root was achieved with 2.5 Volts. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to the right L3 root  was achieved using 2 bended catheters 10 mm exposed length. Further bipolar motor stimulation of the right L3 root was achieved with 2.0 Volts. The patient was put in Reverse Trendelenburg position with Valsalva maneuver and hyperventilation. No CSF leak. Routine closure of the wound

Smooth postoperative recovery. The radicular pain decreased and the power of right foot normalized. He was sent to the ward.