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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 .

23-JANUARY-2019  HAZEM UTHMAN DODIN  34 YEARS  EXTRUDED DISC L4-5 WITH FAR LEFT DOWNWARD MIGRATION.

 
 

Anamnesis

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The patient came to the clinic 20-January-2019 complaining of LBP for 4 years, intermittent with left sciatica for 5 months, down to the lateral aspect of the left ankle joint. MRI lumbar done 19-December-2018 showing extruded disc L4-5 with left downward migration.

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On examination: He is limping  with scoliotic stance with agonizing sciatica. SLRS was 5 degrees left side with severe pain and 80 degrees in the right without pain. There was weak dorsiflexion left foot -4/5.

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The patient was sent for investigations and MRI performed 20-January-2019 showing the same extrusion of L4-5 with left downward migration and bulge L5-S1. UA was 7.0 mg/dL and CRP was 9.5 mg/L.

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Left sided partial hemilaminectomy of L4 and upper 2/3 of L5. Foraminotomy of the left L5  root with subaxillary removal of the extrusion and left sided cleaning L4-5 disc space. The L5 root was pushed lateral and after release, became visible and relax. Using MultiGen, bipolar motor stimulation of the left L5 root was achieved with 1.7 Volts. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to 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 1.3 V with more brisk response as before. The patient was put in Reverse Trendelenburg position with Valsalva maneuver. No CSF leak. Routine closure of the wound.

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Smooth postoperative recovery. The power of the left foot improved and the sciatica disappeared. He was sent to the ward.


MultiGen

Comments  

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There is still an estimated postoperative re-recurrence around 7%, because the disc space height is still not shallow.

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This is the 173d 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 stimulation power of motor stimulation of the affected root after application improved dramatically after BPRF.

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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.

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

 


 

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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