Inomed Stockert Neuro N50. A versatile
RF lesion generator and stimulator for
countless applications and many uses
Multigen RF lesion generator .
10-AUGUST-2017 HANA MUHAMED SHAHER 39 YEARS
EXTRUDED DISC L4-5 WITH RIGHT DOWNWARD MIGRATION.
The patient came to the clinic 02-August-2017
complaining of LBP with right sciatica for 1 month
with numbness all toes right foot. MRI
lumbar spine performed 15-July-2017 showing
extruded disc L4-5 with right downward
migration. In comparison to MRI performed
24-February-2016 the extrusion became bigger.
On examination, the patient is limping with exaggerated scoliotic
was 70 degrees with pain in the right. There is weak dorsiflexion
right foot 3/5. The left AJ is absent?
The patient was sent for investigations and
dynamic studies ruled out overmobility and Lab
investigations showed ESR 30 mm/h for what she
was advised to start Zinnat 500 twice a day.
root was achieved. The extruded disk was removed
lateral to the axilla from right side.
Right sided intradiscal cleaning of L4-5 disc space was performed.
For the future project, an hexagonal Allen key
No 6 was easily going inside the annulus
fibrosis defect, but No 8 was difficult. Using MultiGen, bipolar motor stimulation of the
was achieved with 0.8 V. A
bipolar pulsed mode
RF with 42 Celsius, 240 sec, 2 Hz and 20 msec
duration to the right L5 root was achieved using
2 bended catheters 10 mm exposed length. Further
bipolar motor stimulation of the right L5
was achieved with 0.5 V.
Routine closure of the
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 130th 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
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.