The patient came to the clinic 03-September-2013 complaining of LBP for 15 years with right sciatica. Bilateral sciatica the last 4 years with inability to walk more than 300 meters.  Investigations were performed and spondylolisthesis L5-S1 was diagnosed and she was advised for surgery. The patient then came to the Emergency Shmaisani hospital 25-December-2015 complaining of LBP with agonizing bilateral sciatica the last 10 days with fainting attacks, neck pain and nausea. This took place after the death of relative and persisted until she was transferred from Yemen to Jordan.

On examination: the patient is in agonizing pain in bed. There is weak dorsi and planterflexion both feet 3/5. Positive cough sign. The patient was exposed to thorough neuro-cardio-endocrine investigations and MRI of the brain was normal. MRI of the cervical spine showed bulge C5-6. MRI of the lumbar spine confirmed the previous spondylolisthesis and CXR and Chest CT-scan showed enlarged thyroid with calcification. Dynamic studies confirmed the mentioned spondylolisthesis.

Transpedicular fixation L5 and S1, using XIA 3 system with 3 screws monoaxial 6.5x45 mm to L5 body and right side sacrum and one screw 6.5x40 mm to the left side. Bilateral  S1 foraminotomy was performed. Using MultiGen, a pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to the S1 roots was achieved.   Routine closure of the wound.

Smooth postoperative recovery. The power of both feet became normal. The patient was sent to the ward.

The patient has an persistent bilateral sciatica with LBP for many years. Fixation is the only solution for her problem.

This is the 22nd case using the PRF mode with MultiGen. This procedure regained routine acceptance  it will be a usual part of the spine surgery.