The patient came to the clinic 05-January-2017 complaining of LBP and left sciatica for several months. He was operated elsewhere 1981, 1996 and 2012 with unknown data to the spine with very long incision reaching the coccygeum. MRI lumbar spine performed 26-October-2016 showing huge extruded disc L4-5 with left downward migration. The patient is a known diabetic for 4 years in treatment.

On examination, the patient is in agonizing pain, limping with exaggerated scoliotic stance. SLRS was 5 degrees in the left side with pain. There is weak left foot dorsiflexion 2/5, dorsiflexion other foot 3/5.

The patient was sent for new investigations and MRI lumbar spine performed 08-January-2017 showing the same huge extruded disc L4-5 with left up and downward migration. Dynamic studies were uneventful. ESR was 40 mm/h after teeth manipulation. Cardio consultation was uneventful.

VITOM endoscopic facility was used for operation. Left L5 neurolysis and foraminotomy was achieved. The Level of the L4-5 was identified with scarolysis of the left L5 root. The extruded disk was removed lateral to the axilla under the L5 root. Left sided cleaning of L4-5 was performed. Using MultiGen, bipolar motor stimulation of the left L5 was achieved with 2.4 V. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to the left L5 root was achieved using 2 bended catheters 10 mm exposed length. Further motor stimulation done to the same root and the response was 2.1 V in the left L5 with more brisk response. Routine closure of the wound.

Smooth postoperative recovery. The power of the left foot improved and he was sciatica free. He was sent to the ward.

The patient still having an estimated postoperative recurrence less than 7%, because the disc space is shallow.

This is the 100th 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 tell that the electrodes did not migrate during the procedure and the nerve is functioning properly. Here there was considerable improvement of the threshold of stimulation power of motor stimulation after the BPRF.

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 anaesthesia protocol also the same. In this case adhesions could be a factor for initial high voltage requirement to achieve motor response.