Most of the site will reflect the ongoing surgical activity of Prof. Munir Elias MD., PhD. with brief slides and weekly activity.

Functional Neurosurgery

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Inomed Stockert Neuro N50. A versatile
RF lesion generator and stimulator for
countless applications and many uses

Multigen RF lesion generator .





The patient came to the clinic 04-December-2017 complaining of agonizing LBP with right sciatica for 1 month with exacerbation last 3 days. The patient has no other associated pathologies. MRI lumbar spine performed 28-November-2017 showing huge extruded disc L5-S1 with right foraminal occlusion. Pelvis MRI was normal.


On examination, the patient is hard to evaluate for limping with scoliotic stance, because she is in bed. SLRS was 5 degrees in the right with pain and 40 degrees in the left shooting to the right hip. There is weak dorsiflexion right foot -3/5, planterflexion same foot 3/5 with analgesia right S1 root territory with absent right AJ reflex.


Foraminotomy of right S1 root was achieved. The extruded disk was removed lateral to the axilla from right side. It was not contained for what the agonizing pain took place. Right sided intradiscal cleaning of L5-S1 disc space was performed. For the future project, an hexagonal Allen key No 4 was easily going inside the annulus fibrosis defect, but No 5 was possible with slight resistance. Using MultiGen, bipolar motor stimulation of the right S1 root was achieved with 1.6 V. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to the right S1 root was achieved using 2 bended catheters 10 mm exposed length. Further bipolar motor stimulation of the right S1 was achieved with 1.5 V. Routine closure of the wound.


Smooth postoperative recovery. The power of the right foot 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 140th 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 root after application was better.


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.

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

Leica HM500
The World's first and the only Head mounted Microscope.
Freedom combined with Outstanding Vision, but very bad video recording and documentation.

TRUMPF TruSystem 7500

After long years TRUMPF TruSystem 7500 is running with in the neurosuite at Shmaisani hospital starting from 23-March-2014


MRI showing the extruded disc L5-S1.


Back Up!

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 .
















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