Inomed Stockert Neuro N50. A versatile
RF lesion generator and stimulator for
countless applications and many uses
Multigen RF lesion generator .
25-JULY-2017 DANA NAJEEB ALIYAN 30 YEARS HUGE
EXTRUDED DISC L4-5 CENTRAL MORE TO THE RIGHT.
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
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
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
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
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.