The patient came to the clinic 13-April-2016 complaining of LBP for 10 years, right sciatica for 1 month down to the soleus muscle. MRI lumbar done 12-April-2016 showing extruded disc L4-5 with right downward migration and severe segmental stenosis and bulge L5-S1. The patient is a known hypertensive under treatment for 3 years taking baby aspirin daily.

On examination: the patient is limping with exaggerated scoliotic stance. SLRS was 80 degrees right side with pain. There is weak dorsiflexion right foot -4/5. The patient was reluctant and given chance for conservative measures, but he came 23-April-2016 claiming for surgery.

The patient was sent for investigations. MRI lumbar spine repeated 23-April-2016 showing extruded disc L4-5 with central and downward right migration and severe segmental stenosis. Dynamic studies ruled out overmobility. Uric acid was 8.1 mg/L. The patient was sent for cardio evaluation and asked to stop baby aspirin for 5 days before surgery.

Decompressive laminectomy of L4 and upper half of L5 was achieved. Foraminotomy both L5 roots was done. The disc space was inspected and overmobility was negative. The extruded disc was removed from right side and right sided cleaning of L4-5 was achieved. Using MultiGen, stimulation of the right nerve was achieved with 1.8 V and the left with 2 V. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to both L5 root was achieved using 4 bended catheters 10 mm exposed length.  Routine closure of the wound.

Smooth postoperative recovery. The patient is sciatica free. The power of both limbs 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 54th 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.