The patient came to the clinic 09-May-2016 complaining of LBP for 11 days with left sciatica. Today she got loss of sensation of the antero-medial aspect of the left foreleg. The patient was operated by me before 1999 for PLD L5-S1 and later for PLD L3-4. She underwent total left knee replacement 3 months ago. 

On examination: the patient is limping with exaggerated scoliotic stance. SLRS was 80 degrees left side with pain. There is weak dorsiflexion right foot 4/5, -4/5 left foot.

The patient was sent for investigations. MRI lumbar spine performed 09-May-2016 showing extruded disc L4-5 with left foraminal and upward migration. Dynamic studies ruled out overmobility with old stable spondylolisthesis L5-S1.

Using the C-arm,  left decompressive laminectomyL4-5 was achieved. Foraminotomy left L5 roots was done. The disc space was inspected and overmobility was negative. The extruded disc was removed from left side and left sided cleaning of L4-5 was achieved. Using MultiGen, stimulation of the left nerve was achieved with 1.5 V. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to left L5 root was achieved using 2 bended catheters 10 mm exposed length. Further motor stimulation done to the same root and the same response was noted. Routine closure of the wound.

Smooth postoperative recovery. The patient is sciatica free. The power of left limb normalized and he 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 56th 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.