The patient came to the clinic 22-July-2017 complaining of LBP for 18 months with right sciatica. The last month the condition deteriorated further with bilateral sciatica more the left and numbness all toes both feet. MRI done 15-May-2017 showing very huge extruded disc L4-5 central more to the right.

On examination, the patient is in agonizing pain, limping with exaggerated  scoliotic stance. She cannot walk more than 5 minutes. SLRS was 20 degrees with pain in both sides with more pain in the left. There is weak dorsi and planterflexion both feet -3/5, weak planterflexion both feet 4/5.

The patient was sent for investigations and dynamic studies ruled out overmobility and Lab investigations were within normal limits. MRI repeated 22-July-2017 showing the same previous extrusion.

Foraminotomy of both L5 roots was achieved. The extruded disk was removed lateral to the axilla of the right L5 root. Bilateral intradiscal cleaning of L4-5 disc space was performed. Both L5 roots were inspected to rule out any remnants of extrusion. Using MultiGen, bipolar motor stimulation of the right L5 was achieved with 0.7 V. The left L5 root with 0.6 V. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to both L5 roots was achieved using 4 bended catheters 10 mm exposed length. Further bipolar motor stimulation of both L5 roots was the same as before the application. 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 127th 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 roots 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.