Inomed Stockert Neuro N50. A versatile
RF lesion generator and stimulator for
countless applications and many uses
Multigen RF lesion generator .
26-MARCH-2017 KHALED IBRAHEEM SALAMEH 47 YEARS
HUGE EXTRUDED DISC C5-6 CENTRAL WITH RIGHT FORAMINAL OCCLUSION.
The patient came to the clinic 22-March-2017
complaining of neck, right upper limb pain and
numbness right hand for 45 days and numbness
right foot the last 2 days with cephalgia. MRI
cervical spine performed 11-March-2017 showing
huge extruded disc C5-6 central with right
foraminal occlusion. The patient in Concor
2.5 mg once daily for 5 years.
On examination, the patient is in agonizing
pain. He has pain when
turning the head to the left, up, down, and when
bending the head to both shoulders, more to the
left. There is weak flexion, extension right
hand -4/5 and right triceps 3/5. There is also
weak dorsiflexion right foot 4/5.
he patient was sent for cardiac evaluation.
Through anterior approach,
discectomy C5-6 was performed with removal of
the extrusion until the dura was seen all over
the posterior edges of C5 and C6. Using
MultiGen, bipolar motor stimulation of the right
was achieved within the disc space with 2.2 V. A
bipolar pulsed mode
RF with 42 Celsius, 240 sec, 2 Hz and 20 msec
duration to right C6 root was achieved using 2 bended catheters 10 mm exposed length. Further
bipolar motor stimulation of the right C6
was achieved with 2.0 V with more vivid response.
Solis cage 6x12 mm with Vitos bone graft (TCP)
were inserted to disc space. One level Reflex
Hybrid Stryker ACP 16 mm length was used with 4
screws 16x4 mm were used to fuse C5-6. Routine closure of the
wound. All stages of surgery were C-arm guided.
Smooth postoperative recovery. The power of
the right upper limb normalized. He was sent to the ward.
The recurrence rate in cervical disc
surgery is zero.
This is the 113th 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 there was slight improvement of the threshold of stimulation
power of motor stimulation of the right C6 root.
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 4-5 minutes session.