Inomed Stockert Neuro N50. A versatile
RF lesion generator and stimulator for
countless applications and many uses
Multigen RF lesion generator .
HYRIYEH ALI ABU-AQULEH 43 YEARS BULGE DISCI L4-5, L5-S1
WITH LBP AND BILATERAL SCIATICA.
The patient came to the clinic 20-May-2015
complaining of LBP for 1 year with bilateral sciatica
and neck pain and both shoulders pain. MRI
lumbar spine performed 29-April-2015 showing
bulge L5-S1. On examination at that time, she
was not limping with scoliotic stance with weak
flexion, extension right hand 4/5 and the right
triceps muscle. The power and sensation of both
feet were normal. The patient was sent for MRI
of the cervical spine and the pelvis. Dynamic
studies of the lumbar spine with lab
investigations were also requested. MRI of the
cervical spine performed 20-May-2015 showed
bulge disci C4-5, 5-6 and C6-7 with the last
more to the right. Other investigations were
normal. The patient then came 30-August-2017
still complaining of LBP with bilateral sciatica
more the right side. She underwent hysterectomy
1 year ago for the LBP, but the pain persisted.
She cannot tolerate anti-steroidal drugs.
On examination, the patient is not limping with scoliotic
was 80 degrees with pain both sides more the
right. There is weak dorsiflexion
right foot 4/5 with hypalgesia right L5
The patient was sent for investigations and
MRI lumbar spine performed 30-August-2017
showing bulge disci L4-5, L5-S1, dynamic studies ruled out overmobility.
Lab investigations were all normal.
The patient put in supine
position. With local anesthetic, the electrodes
were targeted to both L5 and S1 roots both sides
using the C-arm. Using MultiGen, bipolar
motor stimulation of the right L5 was achieved
with 2.5 V, bipolar motor stimulation of the
left L5 was achieved with 2.6 V, bipolar motor
stimulation of the right S1 was achieved with
2.8 V, bipolar motor stimulation of the left S1
was achieved with 2.5 V. A bipolar pulsed mode RF with 42
Celsius, 240 sec, 2 Hz and 20 msec duration to
the both L5 and S1 roots was achieved using 4
bended catheters 10 mm exposed length. Further
bipolar motor stimulation of the right L5 was
achieved with 2.3 V, bipolar motor stimulation
of the left L5 was achieved with 2.6 V, bipolar
motor stimulation of the right S1 was achieved
with 2.8 V, bipolar motor stimulation of the
left S1 was achieved with 2.2 V.
The power of
the right foot normalized and she was sciatica free.
She complained of the pain of the catheters
insertion and could walk in the operating room.
She was sent to the ward.
The patient came to the clinic 14-September-2017
telling that there no improvement at all. The
power of the right foot normalized, but the
patient worry of morning LBP still the same.
I was hesitating to perform to the patient the
BPRF, but according to the fact that she
underwent hysterectomy of normal uterine one
year ago, shifted me to perform the procedure.
If the patient during performance of BPRF is not
complaining, in the future, stop it. The patient
must be in agonizing radicular pain to meet the
requirement of best results of BPRF.
The patient performed hysterectomy for
LBP without improvement and she cannot tolerate the
non-steroidal medication. The only solution was suggested to
undergo BPRF. It is functionally harmless and
This is the 134th case using the BPRF mode
with MultiGen and the second case in awaken patient. 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 in some roots and 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.
In this case the required voltage for
motor response was relatively high, because the tips were
relatively wide apart.