The patient was operated by me 24-October-2012 for huge extruded disc L5-S1 with right upward migration. The patient then came to the clinic 11-February-2016 telling that he was under treatment for Hodgkin lymphoma and was treated with chemotherapy for one year during 2013. During the treatment he started to suffer of numbness of four limbs. During the last weak he progressed severe bilateral sciatica with numbness of both lower limbs with difficult walking. MRI lumbar spine performed 29-September-2015 showed severe lumbar canal stenosis L3-4.

On examination: the patient is limping with scoliotic stance. SLRS was 20 degrees in the right with pain  and 30 degrees with pain in the left. There is weak both quadriceps femoris, adduction, abduction of the both knees 4/5. Weak dorsiflexion right foot 2/5, left foot 3/5 and planterflexion both feet 3/5. Sensation was preserved for pin brick. 

The patient was sent for investigations and MRI done the same day showing a normal MRI of the dorsal spine with severe segmental stenosis at L3-4 and L4-5 levels. Dynamic studies were not convincing to rule out overmobility. The patient was sent for cardio consultation. 

Skeletonization of L3,4 and check for instability or overmobility was negative. Decompressive laminectomy of L3, 4 and the remnant of L5 with foraminotomy both L4 roots. The ligamentum flavum left in the inferior border of the exposed field was left in place, but bisected to expand the dura. Using MultiGen, a bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to both L4 roots was achieved using 4 bended catheters 10 mm exposed length. Routine closure of the wound.

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

The patient have a chance for less recovery after surgery due to the previous chemotherapy.

This is the 33rd 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.