Inomed Stockert Neuro N50. A versatile
RF lesion generator and stimulator for
countless applications and many uses
Multigen RF lesion generator .
11-JANUARY-2017 YASEEN KHALEEL BADRAN 70 YEARS
EXTRUDED DISC L4-5 WITH LEFT DOWNWARD MIGRATION.
The patient came to the clinic 05-January-2017
complaining of LBP and left sciatica for several
months. He was
operated elsewhere 1981, 1996 and 2012 with
unknown data to the spine with very long
incision reaching the coccygeum. MRI lumbar spine performed
26-October-2016 showing huge extruded disc L4-5
left downward migration. The patient is a known
diabetic for 4 years in treatment.
On examination, the patient is in agonizing
pain, limping with exaggerated scoliotic stance. SLRS was
5 degrees in the left side with pain. There is weak
left foot dorsiflexion 2/5, dorsiflexion other
The patient was sent for new investigations and
MRI lumbar spine performed 08-January-2017
showing the same huge extruded disc L4-5 with left
up and downward migration. Dynamic studies were
uneventful. ESR was 40 mm/h after teeth
manipulation. Cardio consultation was
VITOM endoscopic facility was
used for operation. Left L5 neurolysis and foraminotomy
was achieved. The Level of the L4-5 was
identified with scarolysis of the left L5 root. The extruded disk was removed
lateral to the axilla under the L5 root. Left sided cleaning of L4-5 was
performed. Using MultiGen, bipolar motor stimulation of
the left L5 was achieved with 2.4 V. A
bipolar pulsed mode
RF with 42 Celsius, 240 sec, 2 Hz and 20 msec
duration to the left L5 root was achieved using
2 bended catheters 10 mm exposed length. Further
motor stimulation done to the same root and the
response was 2.1 V in the left L5 with more
brisk response. Routine closure of the
Smooth postoperative recovery. The power of
the left foot improved and he was sciatica free.
He was sent to the ward.
The patient still having an estimated
postoperative recurrence less than 7%, because the disc
space is shallow.
This is the 100th 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 the 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 anaesthesia
protocol also the same. In this case adhesions could be a
factor for initial high voltage requirement to achieve motor