The patient was operated by me 29-September-1999 for extruded disc L4-5 with drop right foot. The patient then came 08-October-2003 with recurrent disc L4-5 and was operated for the recurrence 18-October-2003. The patient then came 15-April-2017 complaining of LBP with bilateral sciatica for 10 days. The patient felt down 1 month ago. He is hypertensive for 2 years in Omnic for prostate hypertrophy for 1 year.

On examination, the patient is limping with exaggerated  scoliotic stance. SLRS was 60 degrees with pain in the right. There is weak dorsiflexion right foot 3/5. There is pain of the right lower abdominal quadrant due to muscle spasm.

The patient was sent for investigations and MRI lumbar spine performed 15-April-2017 showing lumbar canal stenosis L2-3, 3-4. MRI pelvis showed prostate hypertrophy and dynamic studies ruled out overmobility and Lab investigations showed ESR 40 mm/h and CRP 7 mg/L for what she was advised to start Zinnat 500 twice a day.

The patient then came 29-July-2017 telling that he is using crutches for 2 months and cannot walk more than 10 meters, for what he was advised to stop anticoagulants and to be seen by cardiologist before intended surgery.

Decompressive laminectomy L2,3 and remnants of L4. Foraminotomy L3,4 both sides. Using MultiGen, bipolar motor stimulation of the right L3 was achieved with 2.0 V. The left L3 with 1.4 V. The right L4 root was with 1.2 V and the left with  2.2 V. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to the right L5 root was achieved using 4 bended catheters 10 mm exposed length. Further bipolar motor stimulation of the right L3 was achieved with 1.5 V. The left with 1.1 V. The right L4 root with 1.1 V, the left with 2.2 V. Routine closure of the wound.

Smooth postoperative recovery. The power of the left foot normalized and the left foot became better. He became sciatica free. He was sent to the ward.

The patient came to the clinic 23-October-2017 with clean wound, still complaining of hip pain with bilateral sciatica, but the walking improved. Still having drop right foot with hypalgesia right L5 and S1 territories. The patient sent for investigations and given medications, but he disappeared.

The patient previously had drop right foot. With the years the drop foot got slight improvement.

This is the 131st case using the BPRF mode with MultiGen. This procedure regained routine acceptance.  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 the threshold of stimulation power of motor stimulation of the roots after application were variable, but some of them better.

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.