The patient came to the clinic 02-June-2016 complaining of LBP with left sciatica for 1 month with inability to walk. MRI lumbar spine performed 12-May-2016 showing huge extruded disc L5-S1 with wide-based more to the left. The patient is a known diabetic for 2 months.

On examination: the patient is in agonizing pain, limping with exaggerated scoliotic stance. SLRS was 60 degrees in the right with pain and 30 degrees left side with more pain. There is weak dorsiflexion left foot 4/5 and planterflexion both feet 4/5. There is hypalgesia left L5 and S1 territories with absent AJ in the left.

Using the C-arm, the L5-S1 level was identified and foraminotomy left S1 root was achieved with preservation and reflection of the ligamentum flavum to the right trying to keep the epidural fat. The extruded disk was removed from left side and left sided cleaning of L5-S1 was performed. The disc material was soft, watery as having an inflammatory process.  Using MultiGen, stimulation of left S1 root was achieved with 2.1 V. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to both L5 and right S1 roots was achieved using 2 bended catheters 10 mm exposed length. Further motor stimulation done to the same root and the response was 1.8 V. Routine closure of the wound.

Smooth postoperative recovery. The patient is sciatica free. The power of both feet 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 63rd 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.

It still unclear to evaluate the differences of pre and post application motor responses. The only sure thing that it tell that the electrodes did not migrate during the procedure and the nerve is functioning properly.