Inomed Stockert Neuro N50. A versatile
RF lesion generator and stimulator for
countless applications and many uses
Multigen RF lesion generator .
30-MAY-2016 BAKIL MUHAMED AL-QALALAH 65 YEARS
HUGE EXTRUDED DISK L4-5 CENTRAL WITH SEVERE SEGMENTAL STENOSIS.
Anamnesis
The patient came to the clinic
27-April-2014 complaining of LBP with bilateral sciatica for
10 years with exacerbation last 4 years. MRI
lumbar spine performed 21-April-2014 showing
huge extruded disc L4-5 with severe segmental
stenosis with bulge L5-S1. Dynamic studies were
normal. The patient at that time was not limping
with no scoliotic stance. There was weak
dorsiflexion both feet -4/5. He was advised to
undergo surgery, but escaped. The patient then
came 24-May-2016 with the same complains with
bilateral sciatica more the right.
On examination: the patient is not limping now with
mild scoliotic
stance. SLRS was 80 degrees in the right with
pain and 90 degrees left side without pain. There is weak
dorsiflexion both feet 3/5 and planterflexion
right foot 4/5.
The patient was sent for investigations and MRI
lumbar spine performed 25-May-2016 showing
huge wide-based extrusion L4-5 with severe
segmental stenosis and bulge L5-S1 more to the
right. Dynamic studies unremarkable.
Using the C-arm, the
L4-5 level was identified and
foraminotomy both L5 roots was achieved. There
was a tear due to severe stenosis about 10 mm,
which was repaired by nylon 6 zero. The extruded disk was removed from
both sides and bilateral cleaning of L4-5 was
performed. Right L 5 hemilaminectomy with
foraminotomy right S1 root. The extruded disc
was removed and right sided cleaning of L5-S1
was achieved. The disc space was very shallow. Using MultiGen, stimulation of both
L5 nerves was achieved with
1.5 V. The right S1 was responding to 2.5 V. A
bipolar pulsed mode
RF with 42 Celsius, 240 sec, 2 Hz and 20 msec
duration to both L5 and right S1 roots was achieved using 4 bended catheters 10 mm exposed length. Further
motor stimulation done to the same roots and the
responses were 1.3 V for the right L5 root, 1.5
V for the left and 1.8 for the right S1 root. Routine closure of the
wound.
Smooth postoperative recovery. The patient
is sciatica free. The power of both feet
normalized and he was sent to the ward.
MultiGen
Comments
The patient still have an estimated
postoperative recurrence around 7%, because the disc space
is still not shallow.
This is the 62nd case using the BPRF mode
with MultiGen. This procedure regained routine acceptance it
became
a usual part of the spine surgery.
Click here for
reference.
It still unclear 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.
Skyra MRI with all clinical applications in the run since 28-Novemeber-2013.
Inomed Riechert-Mundinger System, with three point
fixation is the most accurate system in the market. The microdrive and
its sensor gives feed back about the localization.
Inomed MER system
Leica HM500
The World's first and the only Headmounted Microscope.
Freedom combined with Outstanding Vision, but very bad video recording and
documentation.
After long years TRUMPF TruSystem 7500 is running with in the neurosuite at
Shmaisani hospital starting from 23-March-2014
Notice: Not all operative activities
can be recorded due to lack of time.
Notice: Head injuries and very urgent surgeries are also
escaped from the plan .