The patient came to the clinic 04-October-2017 complaining of LBP with right sciatica for 10 days. The patient is a known diabetic for 5 years and hypertensive for 4 years under treatment.

On examination, the patient is in agonizing pain, limping with exaggerated scoliotic stance. SLRS was 10 degrees with pain in the right and 70 degrees in the left. There is weak dorsiflexion both feet 4/5.

The patient was sent for investigations and MRI lumbar spine showed extruded disc L3-4 with right foraminal occlusion with stenosis same level. MRI of the pelvis unremarkable. Dynamic studies ruled out overmobility. Lab investigations ruled out presence of infection. Cardio consultation was unremarkable.

Laminectomy L3 and upper part of L4. Foraminotomy of right L4 root was achieved. The extruded disk was removed lateral to the axilla from right side. Right sided intradiscal cleaning of L3-4 disc space was performed. For the future project, an hexagonal Allen key No 4 was easily going inside the annulus fibrosis defect, but No 5 was possible with slight resistance. Using MultiGen, bipolar motor stimulation of the right L4 root was achieved with 1.8 V. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to the right L4 root was achieved using 2 bended catheters 10 mm exposed length. Further bipolar motor stimulation of the right L4 was achieved with 1.6 V. Routine closure of the wound.

Smooth postoperative recovery. The power of both feet normalized and she was sciatica free. She was sent to the ward.

The patient still having an estimated postoperative recurrence around 7%, because the disc space is still not shallow.

This is the 136th 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 root after application was 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.