Inomed Stockert Neuro N50. A versatile
RF lesion generator and stimulator for
countless applications and many uses
Multigen RF lesion generator .
24-APRIL-2017 YOUSEF ALI AL-SHEIKH 24 YEARS
HUGE EXTRUDED DISC L5-S1 WITH CENTRAL MORE TO THE RIGHT.
The patient came to the clinic
complaining of LBP for 1 week with bilateral
sciatica more the left for 2 days with
exacerbation last day of the sciatica with
numbness both feet and more pain in the left
foot. MRI lumbar spine performed 23-April-2017
showing huge extruded disc L5-S1 central
wide-based more to
the right, causing severe segmental stenosis.
On examination, the patient is in agonizing
pain, limping with exaggerated scoliotic stance. SLRS
was 25 degrees with pain in both sides. There is weak
dorsiflexion left foot -4/5, right foot 4/5 and planterflexion
right foot 4/5.
Decompressive laminectomy L5
and upper sacrum with foraminotomy
both S1 roots. The extruded disk was removed
lateral to the axilla of the right S1 root.
Bilateral cleaning of L5-S1 disc space was performed.
The right S1 root was shifted up and lateral and
the cleaning was performed subaxillary. Using
MultiGen, bipolar motor stimulation of the left
was achieved with 0.9 V. The right s1 was
achieved with 0.7 V. Waiting 4 minutes the same procedure
repeated and bipolar motor stimulation of the
left S1 was achieved with 0.8 V, bipolar motor
stimulation of the right S1 was achieved with
0.6 V. A
bipolar pulsed mode
RF with 42 Celsius, 240 sec, 2 Hz and 20 msec
duration to both S1 roots was achieved using
4 bended catheters 10 mm exposed length. Further
bipolar motor stimulation of the left S1 was
achieved with 0.7 V, bipolar motor stimulation
of the right S1 was achieved with 0.4 V.
Routine closure of the
Smooth postoperative recovery. The power of
both feet 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 115th 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 there was considerable improvement of the threshold of stimulation
power of motor stimulation of the both S1 roots.
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. This trail was
performed intentionally to confirm or exclude such this
conclusion. Here we noticed that the motor response of both
nerves improved after first stimulation, confirming that the
improvement came as a result of previous stimulation and
BPRF still adding further improvement.