The patient came to the clinic 08-September-2019 complaining of severe neck pain for 2 years with left shoulder down to the elbow. MRI cervical spine performed 24-October-2018 showing bulge C3-4 and C5-6. The patient underwent BPRF for lower spine 18-January-2016 and telling that he got considerable improvement.

On examination: He is in agonizing neck pain, with pain more to up and down and bending the head to the left shoulder with limitation of movement. There is weak extension left hand 4/5 and the left triceps 4/5.

The patient was sent for investigations: MRI cervical spine performed 08-September-2019 showing bulge disci C3-4, 5-6 and C6-7. Dynamic studies ruled out overmobility. Lab examinations were normal. The patient is addict to tramal, Lyrica and receiving tryptizol 25 mg at bed time. The patient is asking for BPRF to the cervical spine.

Using the C-arm, the location of the left C6,C7 were identified. Using MultiGen, motor stimulation of both roots were achieve and BPRF for 4 min with 2 Hz and 42 C Celsius was applied to both mentioned roots. The patient is telling that the pain at the neck disappeared but still having minimal pain of the posterior aspect of the left shoulder.

The recent case was decided with hesitance, because he is addict to certain medications, but considering that he had previous experience with such acceptable results in the lower back, it was decided to proceed with BPRF.

This is the 183d 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.

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 we did not perform motor stimulation of the severely affected nerves after BPRF.

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.

After the 172d case, the elevation of motor stimulation above 5 V was abandoned to avoid delayed dural tear with subsequent CSF leak, which take place at the contact at the lower electrode shaft with the dura below the level of the axilla.