Inomed Stockert Neuro N50. A versatile
RF lesion generator and stimulator for
countless applications and many uses
Multigen RF lesion generator .
24-JANUARY-2017 AHMAD FAYEQ ABU-SAMHAN 35 YEARS HUGE
DISC L4-5 WITH RIGHT UPWARD MIGRATION.
The patient was operated by me
22-January-2017 for recurrent disc L4-5 with
right upward migration and after the surgery
continued to complain of right buttock pain. The
pain was agonizing one and when walking there
was no sciatica, but when returning to sleep in
bed and turning to the right side, the pain was
agonizing. MRI done 23-January-2017 showed huge
fresh re-recurrence of the same disc.
The wound was opened.
Exploration of the wound. Further foraminotomy
of right L4 root. The extruded disk from the
L4-5 was reaching and compressing the axilla of
right L4 root. It was missed during the first
surgery, then removed now after what the root
became lax. Further right sided cleaning of L4-5 was
performed. Foraminotomy of the right L5 root was
performed. Using MultiGen, bipolar motor stimulation of
the right L4 was achieved with 0.8 V. The
right L5 root responded to 1.5 V. A
bipolar pulsed mode
RF with 42 Celsius, 240 sec, 2 Hz and 20 msec
duration to the right L5 root was achieved using
2 bended catheters 10 mm exposed length. Further
motor stimulation done to the last root and the
response was 1.3 V with more
brisk response. Routine closure of the
Smooth postoperative recovery. The
patient was sciatica free.
He was sent to the ward.
The patient still having an estimated
postoperative third recurrence less than 7%, because the disc space
is shallower than before. The recurrence immediately after
surgery is very rare and during 37 years , it is the fourth
case making the estimated recurrence in this case around
This is the 103d case using the BPRF mode
with MultiGen. This procedure regained routine acceptance.
It became a usual part of the spine and peripheral nerves
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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, but adhesions were relatively minimal around the
root, for what considerable improvement was achieved.
The root motor response of right L4 in
previous surgery was 1.8 V which improved to 0.6 V and now
is 0.8 V. It means that the effect of the manipulation still
persisting after 48 hours after surgery.
The clinical picture of recurrence or
missed fragment with application of BPRF is different from
the usual recurrence without BPRF.