Inomed Stockert Neuro N50. A versatile
RF lesion generator and stimulator for
countless applications and many uses
Multigen RF lesion generator .
25-MAY-2017 ZAHER ALI AL-QADUMI 50 YEARS EXTRUDED
DISC D7-8, L2-3 WITH CAUDA EQUINA SYNDROME AND DROP BOTH FEET.
The patient was operated by me
for PLD L4-5 and did well. The patient then came
24-May-2017 transferred from another hospital
with full blown picture of cauda equina syndrome
for 5 days with drop left foot for 5 days and
drop right foot and dripping urine for 3 days.
On examination, the patient is in agonizing
pain, sent by imbalance, lying in the left side,
very difficult to exam him. SLRS was 35 degrees
in the right with pain and 10 degrees with more
pain in the left. Dorsiflexion both feet and
planterflexion left foot was 0/5. Planterflexion
right foot 3/5. There is hypalgesia below the
left knee and below the right L5 root
territories. Loss of urine control.
The patient was sent for investigations and MRI
of the dorsal spine showed huge extrusion D7-8
and lumbar spine performed the same day showing
extruded disc L2-3 with left foraminal
occlusion and severe segmental stenosis.
Discectomy D7-8 was performed
from right fenestration. Decompressive
laminectomy L2-3 was achieved. Foraminotomy of
both L3 roots was performed. The extruded disk was removed
subaxillary of the left L2 root.
Left sided intradiscal cleaning of L2-3 disc space was performed.
The left L3 root was inspected to rule out any
remnants of extrusion. Inspection of the other
right side was uneventful. Using
MultiGen, bipolar motor stimulation of both
was achieved with 0.6 V. A
bipolar pulsed mode
RF with 42 Celsius, 240 sec, 2 Hz and 20 msec
duration to both L3 roots was achieved using
4 bended catheters 10 mm exposed length. Further
bipolar motor stimulation of both L3 roots was
achieved with 0.6 V.
Routine closure of the
Smooth postoperative recovery. The power of
the right foot considerably improved, but the left foot
still the same 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. The 2 extrusions could be blamed
for his dilemma, for what discectomy both extrusions with
adequate decompression of L2-3 was performed.
This is the 121st 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 motor response was the same before and
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.
We stopped the several motor activations
before BPRF in several sessions, because we got a clear idea
and here the damaged roots are at the cauda equina level.