Inomed Stockert Neuro N50. A versatile
RF lesion generator and stimulator for
countless applications and many uses
Multigen RF lesion generator .
11-JULY-2017 ABDELHAMEED BASHEER ALDUWAYK 84 YEARS
SEVERE LUMBAR CANAL STENOSIS L2-3, 3-4 AND L4-5 WITH OLD DROP LEFT FOOT.
The patient was operated by me
cervical canal stenosis, after what the upper
limbs improved and slight improvement of the
lower limbs. The patient came several times and
in 05-June-2016 he could walk without crutches,
but drop left foot was noted. The planterflexion
both feet was normal and dorsiflexion right foot
was 3/5. The patient then came 24-May-2017
telling that walking is deteriorating the last 2
On examination, the patient is limping with exaggerated scoliotic stance,
walking bended anterior. SLRS
was 70 degrees with tightness both sides. There
is weak dorsiflexion right foot -3/5, weak
planterflexion right foot 3/5, drop left foot
with weak planterflexion left foot 3/5.
The patient was sent for investigations and
MRI whole spine performed showing good alignment
of the cervical spine, but severe stenosis L2-3,
3-4 and L4-5. Dynamic studies ruled out overmobility and Lab
investigations were within normal limits. The
patient was sent for cardio evaluation and to
stop aspirin 10 days before surgery.
L3,4, lower half of L2 and upper half of L5 was
achieved. Foraminotomy of L3,4,5 roots was
performed both sides. Using MultiGen, bipolar motor stimulation of the
right L4 was achieved with 1.5 V, the left L4
with 2.9 V. The right L5
was achieved with 4.3 V, the left L5 with 3.0 V
but only planterflexion. A
bipolar pulsed mode
RF with 42 Celsius, 240 sec, 2 Hz and 20 msec
duration to L4, L5 roots both sides was achieved using
4 bended catheters 10 mm exposed length. Further
bipolar motor motor stimulation of the right L4
was achieved with 1.6 V, the left L4 with 2.8 V.
The right L5
was achieved with 3.0 V, the left L5 with 2.6 V
but only planterflexion.
Routine closure of the
Smooth postoperative recovery. The power of
the right foot normalized and the planterflexion
left foot regained full power, but the drop left
foot remained. He was sciatica free.
He 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 126th 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
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
right L5 root before and after application was the same.
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.
The drop foot of long-standing duration
is less likely to recover.