Inomed Stockert Neuro N50. A versatile
RF lesion generator and stimulator for
countless applications and many uses
Multigen RF lesion generator .
12-AUGUST-2017 SULAYMAN HUSSEIN AL-TAAMARI 75
YEARS LUMBAR CANAL STENOSIS L2-3 AND L3-4.
The patient was operated by me 29-September-1999
for extruded disc L4-5 with drop right foot. The
patient then came 08-October-2003 with recurrent
disc L4-5 and was operated for the recurrence
18-October-2003. The patient then came
15-April-2017 complaining of LBP with bilateral sciatica for 10
days. The patient felt down 1 month ago. He is
hypertensive for 2 years in Omnic for prostate
hypertrophy for 1 year.
On examination, the patient is limping with exaggerated scoliotic
was 60 degrees with pain in the right. There is
weak dorsiflexion right foot 3/5. There is pain
of the right lower abdominal quadrant due to
The patient was sent for investigations and
MRI lumbar spine performed 15-April-2017 showing
lumbar canal stenosis L2-3, 3-4. MRI pelvis
showed prostate hypertrophy and dynamic studies ruled out overmobility and Lab
investigations showed ESR 40 mm/h and CRP 7 mg/L for what she
was advised to start Zinnat 500 twice a day.
The patient then came 29-July-2017 telling that
he is using crutches for 2 months and cannot
walk more than 10 meters, for what he was
advised to stop anticoagulants and to be seen by
cardiologist before intended surgery.
L2,3 and remnants of L4. Foraminotomy L3,4 both sides. Using MultiGen, bipolar motor stimulation of the
was achieved with 2.0 V. The left L3 with 1.4 V.
The right L4 root was with 1.2 V and the left
with 2.2 V. A
bipolar pulsed mode
RF with 42 Celsius, 240 sec, 2 Hz and 20 msec
duration to the right L5 root was achieved using
4 bended catheters 10 mm exposed length. Further
bipolar motor stimulation of the right L3
was achieved with 1.5 V. The left with 1.1 V.
The right L4 root with 1.1 V, the left with 2.2
V. Routine closure of the
Smooth postoperative recovery. The power of
the left foot normalized and the left foot
became better. He became sciatica free.
He was sent to the ward.
The patient previously had drop right
foot. With the years the drop foot got slight improvement.
This is the 131st 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
roots after application were variable, but some of them
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.