Inomed Stockert Neuro N50. A versatile
RF lesion generator and stimulator for
countless applications and many uses
Multigen RF lesion generator .
18-MARCH-2017 ALI MUHAMED ABDEL-HADID 81 YEARS
SEVERE COMPRESSION OF D12-L1 DUE TO LEFT D12-L1 FACET BONY-LIGAMENTEOUS
DEFORMITY AND WEAK LEFT LIMB.
The patient was operated by me
16-June-2015 for severe LCS with
spondylolisthesis L3-4, L4-5, during which
decompressive laminectomy L1 down to L5 with
transpedicular fixation of L2-3-4 was performed.
The patient came many times to the clinic
showing slight improvement of the neurologic
status and several times underwent full
investigations for his surgery. The patient then came to the clinic
06-March-2017 complaining of heaviness of the
left leg with LBP in the sacral area.
On examination, the patient is still using
crutches for walking. SLRS
was 80 degrees left side with pain. There is weak
left quadriceps muscle -4/5. Previously all the
time it was 5/5. Dorsi and planterflexion right foot 3/5
as previous all examination. The power of all
other muscles both legs were 5/5. There is pain
of the left lower chest cage.
he patient was sent for investigations and MRI
lumbar spine performed showing as be huge extruded disc
D12-L1 with central upward migration, more to
the left. The patient
was sent for cardiac evaluation.
D12. The left lateral mass of D12-L1 was
severely compressing the spinal cord. It was
drilled out with removal of the bony and
ligamenteous elements. Foraminotomy left Th12 root.
Inspection of the disc space and around the
root, above the disc space and below did not
reveal any disc extrusion.
MultiGen, bipolar motor stimulation of the left
was achieved with 1.3 V. A
bipolar pulsed mode
RF with 42 Celsius, 240 sec, 2 Hz and 20 msec
duration to left Th12 root was achieved using 2 bended catheters 10 mm exposed length. Further
bipolar motor stimulation of the left Th12
was achieved with 0.6 V with more vivid response. Routine closure of the
Smooth postoperative recovery. The power of
left quadriceps muscle became better. He was sent to the ward.
The patient has very shallow disc space,
that extrusion is impossible to occur. The patient before
surgery was diagnosed as having extrusion, but during
surgery, it became evident that the compression was from the
bony ligamenteous elements of the left facet joint.
After fusion of L2-3-4, the stress point
was added to the D12-L1 segment and it was mostly the cause
of such event.
This is the 112th 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 there was dramatic improvement of the threshold of stimulation
power of motor stimulation of the left D12 root.
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 4-5 minutes session.