Inomed Stockert Neuro N50. A versatile
RF lesion generator and stimulator for
countless applications and many uses
Multigen RF lesion generator .
19-JUNE-2017 MAHMOUD MUHAMED TARKHAN 40 YEARS
EXTRUDED DISC L5-S1 WITH LEFT DOWNWARD MIGRATION.
The patient came to the clinic
complaining of LBP for 4 years with left sciatica with
exacerbation last month with pain and
numbness all toes left foot.
On examination, the patient is in agonizing
pain, not limping with exaggerated scoliotic stance. SLRS
was 75 degrees with pain in left side. There is weak dorsiflexion
left foot -4/5 with hypalgesia left L5 territory.
The patient was sent for investigations and MRI
lumbar spine performed 03-April-2017 showing
extruded disc L5-S1 with left downward migration. Dynamic studies ruled
out overmobility of the spine. Lab
investigations are within normal limits.
Foraminotomy of the left S1
root was achieved. The extruded disk was removed
lateral to the axilla of the left S1 root.
The epidural fat was preserved until the end of
surgery. Left sided intradiscal cleaning of L5-S1 disc space was performed.
The left S1 root was swollen and inspected to rule out any
remnants of extrusion. Using MultiGen, bipolar motor stimulation of the
was achieved with 0.7 V. A
bipolar pulsed mode
RF with 42 Celsius, 240 sec, 2 Hz and 20 msec
duration to the left S1 root was achieved using
2 bended catheters 10 mm exposed length. Further
bipolar motor stimulation of the left S1 was
achieved with 0.6 V.
Routine closure of the
Smooth postoperative recovery. The power of
the left foot normalized and he was sciatica free.
He 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 123d 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 considerable improvement of the
threshold of stimulation power of motor stimulation of the
right S1 root after repositioning.
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.