Inomed Stockert Neuro N50. A versatile
RF lesion generator and stimulator for
countless applications and many uses
Multigen RF lesion generator .
06-AUGUST-2017 NIDA FAYEZ AL-TOBASI 33 YEARS
HUGE EXTRUDED DISC L4-5 WITH RIGHT DOWNWARD MIGRATION.
The patient came to the clinic 27-July-2017
complaining of LBP with left sciatica for 1 month,
then progressed to right
sciatica the last week down with numbness all
toes right foot.
On examination, the patient is in agonizing
pain, limping with exaggerated scoliotic
was 30 degrees with pain in the right and 40
degrees in the left. There is weak dorsiflexion
both feet 4/5.
The patient was sent for investigations and
MRI lumbar spine performed 29-July-2017 showing
huge extrusion L4-5 with right downward
migration. Dynamic studies ruled out overmobility and Lab
investigations showed ESR 25 mm/h. The patient
was advised to start Zinnat 500 mg twice a day
to minimize the postoperative infection rate.
Foraminotomy of right L5
roots was achieved. The extruded disk was far
downward migrating in comparison to the last MRI
about 10 mm below the disc space. It was removed
far away from the axilla of the right L5 root.
Right sided intradiscal cleaning of L4-5 disc space was performed.
The right L5 roots were full of veins, which
were coagulated to achieve proper hemostasis and inspected to rule out any
remnants of extrusion. Using MultiGen, bipolar motor stimulation of the
was achieved with 0.39 V. A
bipolar pulsed mode
RF with 42 Celsius, 240 sec, 2 Hz and 20 msec
duration to right L5 root was achieved using
2 bended catheters 10 mm exposed length. Further
bipolar motor stimulation of the right L5 root was
with 0.34 V.
Routine closure of the
Smooth postoperative recovery. The power of
both feet normalized and she was sciatica free.
She 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 128th 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 the
threshold of stimulation power of motor stimulation of the
root after application was better.
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.