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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 .

14-JANUARY-2002  FAYSAL AHMAD AL-FAQIHI  2.8 YEARS  BLUNT PENETRATING INJURY TO RIGHT ORBIT DOWN TO THE RIGHT FRONTAL LOBE.

 
 

Anamnesis

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The patient came to the clinic 19-December-2020 complaining of LBP with left sciatica for 3 weeks with left sciatica down to all toes left foot. MRI lumbar spine performed 05-December-2020 showing extruded disc L4-5 with left upward migration.

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On examination: The patient is in agonizing pain, limping with exaggerated scoliotic stance. There is weak dorsiflexion left foot -4/5, planterflexion same foot 4/5. SLRS was 10 degrees with pain left side. There is hypalgesia left L5, S1 territories.

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The patient was sent for investigations and WBC in urine was 450 and no bacteria was found. The patient was advised to start Zinnat 500 mg twice daily before the surgery.

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Extended left L5 foraminotomy with removal of the left far upward migrating extrusion and left sided intradiscal cleaning of L4-5.  Using MultiGen, bipolar motor stimulation of the left L5 root was achieved with 1.1 Volts. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to the left L5 root  was achieved using 2 bended catheters 10 mm exposed length. Further bipolar motor stimulation of the left L5 root was achieved with 1.1 Volt. The patient was put in Reverse Trendelenburg position with Valsalva maneuver and hyperventilation. No CSF leak. Routine closure of the wound.

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Smooth postoperative recovery. The power of the left foot improved. She was sent to the ward.


MultiGen

Comments  

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There is still an estimated postoperative disc recurrence around 7%, since the disc space is not completely shallow.

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This is the 206th 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.

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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 motor stimulation of the affected nerve did not change.

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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.

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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.

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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.

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After the 172d case, the elevation of motor stimulation above 5 V was abandoned to avoid delayed dural tear with subsequent CSF leak, which take place at the contact at the lower electrode shaft with the dura below the level of the axilla.

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

LooksCam II in the run.
LooksCam II in the run  starting from  14-March-2020

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 .

WELCOME TO AL-SHMAISANI HOSPITAL

 


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