Inomed Stockert Neuro N50. A versatile
RF lesion generator and stimulator for
countless applications and many uses
Multigen RF lesion generator .
24-JANUARY-2017 RATIBEH YOUSEF ISSA 75 YEARS SPONDYLOLISTHESIS
L4-5 WITH LEFT SCIATICA.
The patient came to the clinic 08-January-2017
complaining of LBP for 7 years with
for 1 month. MRI lumbar spine performed
05-January-2017 showing spondylolisthesis L4-5
II degree with bulge disci L3-4 and L5-S1.
Dynamic studies confirming the overmobility of
L4-5. The patient is a known
diabetic for 2 years in treatment and
hypertensive for 15 years.
On examination, the patient is limping with exaggerated scoliotic stance. SLRS
was 30 degrees left side with pain. There is weak
left foot dorsiflexion 3/5, dorsiflexion and hypalgesia
left L5 territory.
The patient was advised to stop anticoagulants
and to be seen by cardiologist. ESR was 33 mm/h
and CRP was 5.9 mg/L. She was started in Zinnat
500 twice daily before admission.
Skeletonization of L3,4,5 and
until the lateral processes of L4 and L5 were
identified. Using AlphatecSpine system with 2
polyaxial screws 6.5X45 mm to L5 body, 6.5X45 mm
to the left side of L4 and 7.5X45 mm polyaxial
to the right side of L4 body and cross-connector
55 mm and bended rods 5.5 mm thickness and
50 mm length, transpedicular distraction
reduction and fixation of L4-5 was achieved.
Foraminotomy both L5 roots. Using MultiGen, bipolar motor stimulation of
both L5 roots was achieved with 1.1 V right side
and 1.5 V left side. A
bipolar pulsed mode
RF with 42 Celsius, 240 sec, 2 Hz and 20 msec
duration to both L5 roots was achieved using
4 bended catheters 10 mm exposed length. Further
motor stimulation done to the right root was 1.0
V and the left was 1.3 V with more
brisk responses. The harvested bone was melt and
applied lateral to the rods. Routine closure of the
Smooth postoperative recovery. The power of
the feet improved 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 104th case using the BPRF mode
with MultiGen. This procedure regained routine acceptance.
It became a usual part of the spine and peripheral nerves
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It still unclear to evaluate the
differences of pre and post application motor responses. The
only sure thing that it tell 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 after
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 anaesthesia
protocol also the same. In this case adhesions could be a
factor for initial high voltage requirement to achieve motor