Inomed Stockert Neuro N50. A versatile
RF lesion generator and stimulator for
countless applications and many uses
Multigen RF lesion generator .
14-OCTOBER-2017 ODEH RAMADAN SALEM 46 YEARS
RECURRENT DISC L5-S1 WITH RIGHT DOWNWARD MIGRATION.
The patient was operated by me
for extruded disc L5-S1 right side with
foraminal occlusion. he patient then came
several times to the clinic complaining of right
and other times left sciatica. Postoperative MRI
done several times confirming no recurrence of
the disc with dehydrated disc L3-4. The patient
then came 14-September-2017 telling that the
last 2 months got right sciatica down to the
lateral aspect right ankle joint. MRI performed
27-August-2017 showing extruded disc L5-S1 with
right downward migration. The patient underwent
cath and stinting 2011 and 2012.
On examination, the patient is limping with
exaggerated scoliotic stance. SLRS was 45
degrees in the right with pain and 70 degrees in
the left with tightness. There is weak
dorsiflexion right foot 4/5 with hypalgesia
below L1 level?
The patient was sent for investigations and
dynamic studies ruled out overmobility. The
patient was advised to stop anticoagulants and
to be seen by cardiologist.
Refreshment of the old wound
and neurolysis of the right S1 root. Foraminotomy of
root was achieved. The extruded disk was removed
lateral to the axilla from right side.
Right sided intradiscal cleaning of L5-S1 disc space was performed.
For the future project, an hexagonal Allen key
No 4 was easily going inside the annulus
fibrosis defect, but No 5 was possible with
slight resistance. Using MultiGen, bipolar motor stimulation of the
right S1 root
was achieved with 1.7 V. A
bipolar pulsed mode
RF with 42 Celsius, 240 sec, 2 Hz and 20 msec
duration to the right S1 root was achieved using
2 bended catheters 10 mm exposed length. Further
bipolar motor stimulation of the right S1
was achieved with 1.6 V.
Routine closure of the
Smooth postoperative recovery. The power of
the right 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 137th 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.