Percutaneous Cordotomy for Relief of Intractable Pain

1968 ◽  
Vol 68 (12) ◽  
pp. 2594 ◽  
Author(s):  
Barbara Therrien ◽  
James H. Salmon
Keyword(s):  
Intractable Pain ◽  
Percutaneous Cordotomy

scholarly journals Microendoscopy-guided percutaneous cordotomy for intractable pain: case series of 24 patients

2016 ◽  
Vol 124 (2) ◽  
pp. 389-396 ◽  
Author(s):  
Erich Talamoni Fonoff ◽  
William Omar Contreras Lopez ◽  
Ywzhe Sifuentes Almeida de Oliveira ◽  
Manoel Jacobsen Teixeira
Keyword(s):  
Spinal Cord ◽  
Real Time ◽  
Single Channel ◽  
Case Series ◽  
Intractable Pain ◽  
Total Recovery ◽  
Percutaneous Cordotomy ◽  
Real Time Visualization ◽  
Intractable Cancer Pain ◽  
Double Channel

OBJECT The aim of this study was to show that microendoscopic guidance using a double-channel technique could be safely applied during percutaneous cordotomy and provides clear real-time visualization of the spinal cord and surrounding structures during the entire procedure. METHODS Twenty-four adult patients with intractable cancer pain were treated by microendoscopic-guided percutaneous radiofrequency (RF) cordotomy using the double-channel technique under local anesthesia. A percutaneous lateral puncture was performed initially under fluoroscopy guidance to localize the target. When the subarachnoid space was reached by the guiding cannula, the endoscope was inserted for visualization of the spinal cord and surrounding structures. After target visualization, a second needle was inserted to guide the RF electrode. Cordotomy was performed by a standard RF method. RESULTS The microendoscopic double-channel approach provided real-time visualization of the target in 91% of the cases. The other 9% of procedures were performed by the single-channel technique. Significant analgesia was achieved in over 90% of the cases. Two patients had transient ataxia that lasted for a few weeks until total recovery. CONCLUSIONS The use of percutaneous microendoscopic cordotomy with the double-channel technique is useful for specific manipulations of the spinal cord. It provides real-time visualization of the RF probe, thereby adding a degree of safety to the procedure.

scholarly journals Cordotomy for Intractable Cancer Pain: A Narrative Review

2020 ◽  
Vol 3;23 (6;3) ◽  
pp. 283-292
Author(s):  
Salahadin Salahadin
Keyword(s):  
Cancer Pain ◽  
Case Reports ◽  
Case Series ◽  
Review Article ◽  
Intractable Pain ◽  
Spinothalamic Tract ◽  
Duration Of Symptoms ◽  
Percutaneous Cordotomy ◽  
Intractable Cancer Pain ◽  
Pain Improvement

Background: Cordotomy is an invasive procedure for the management of intractable pain not controlled by conventional therapies, such as analgesics or nerve block. This procedure involves mechanical disruption of nociceptive pathways in the anterolateral column, specifically the spinothalamic and spinoreticular pathways to relieve pain while preserving fine touch and proprioceptive tracts. Objectives: The purpose of this review article is to refresh our knowledge of cordotomy and support its continued use in managing intractable pain due to malignant disease. Study Design: This is a review article with the goal of reviewing and summarizing the pertinent case reports, case series, retrospective studies, prospective studies, and review articles published from 2010 onward on spinal cordotomy. Setting: The University of Texas, MD Anderson Cancer Center. Methods: PubMed search of keywords “spinal cordotomy,” “percutaneous cordotomy,” or “open cordotomy” was undertaken. Search results were organized by year of publication. Results: Cordotomy can be performed via percutaneous, open, endoscopic, or transdiscal approach. Percutaneous image-guided approach is the most well-studied and reported technique compared with others, with relatively good pain improvement both in the postoperative and shortterm period. The use of open cordotomy has diminished significantly in recent years because of the advent of other less invasive approaches. Cordotomy in children, although rare, has been described in some case reports and case series with reported pain improvement postprocedure. Although complications can vary broadly, some reported side effects include ataxia and paresis due to lesion in the spinocerebellar/corticospinal tract; respiratory failure due to lesion in the reticulospinal tract; or sympathetic dysfunction, bladder dysfunctions, or Horner syndrome due to unintentional lesions in the spinothalamic tract. Limitations: Review article included literature published only in English. For the studies reviewed, the sample size was relatively small and the patient population was heterogeneous (in terms of underlying disease process, duration of symptoms, previous treatment attempted and length of follow-up). Conclusions: Cordotomy results in selective loss of pain and temperature perception on the contralateral side, up to several segments below the level of the disruption. The plethora of analgesics available and advanced technologies have reduced the demand for cordotomy in the management of intractable pain. However, some patients with pain unresponsive to medical and procedural management, particularly malignant pain, may benefit from this procedure, and it is a viable treatment option especially for patients with a limited life expectancy whose severe, unilateral pain is unresponsive to analgesic medications. Key words: Cancer pain, cordotomy complications, cordotomy indications, intractable pain, open cordotomy, percutaneous cordotomy

High Cervical Percutaneous Cordotomy in Intractable Pain

1978 ◽  
Vol 21 (06) ◽  
pp. 209-212 ◽  
Author(s):  
W. Grote ◽  
K. Roosen ◽  
W. Bock
Keyword(s):  
Intractable Pain ◽  
Percutaneous Cordotomy ◽  
High Cervical

Computed Tomography-guided Percutaneous Cordotomy for Intractable Pain in Malignancy

2009 ◽  
Vol 64 (suppl_1) ◽  
pp. ONS187-ONS194 ◽  
Author(s):  
Yucel Kanpolat ◽  
Hasan Caglar Ugur ◽  
Murat Ayten ◽  
Atilla Halil Elhan
Keyword(s):  
Computed Tomography ◽  
Success Rate ◽  
The Body ◽  
Karnofsky Performance Scale ◽  
Intractable Pain ◽  
Spinothalamic Tract ◽  
Ct Guided ◽  
Cancer Group ◽  
Percutaneous Cordotomy ◽  
Scale Scores

Abstract Objective: Pain, usually a response to tissue damage, is accepted as an unpleasant feeling generating a desire to escape from the causative stimulus. Although, in the early stages of malignant diseases, pain is seen in 5% to 10% of cases, this rate reaches nearly 90% in the terminal stage, and pain becomes a primary symptom. Cordotomy is one of the treatment choices in pain caused by malignancies localized unilaterally to the extremities as well as the thorax and the abdomen. Methods: The target of computed tomography (CT)-guided percutaneous cordotomy is the lateral spinothalamic tract located in the anterolateral region of the spinal cord at the C1–C2 level. Between 1987 and 2007, CT-guided percutaneous cordotomies were performed in 207 patients; most (193 patients) suffered from intractable pain related to malignancy. The patients” pain scores and Karnofsky Performance Scale scores were evaluated pre- and postoperatively. Results: The initial success rate of CT-guided percutaneous cordotomy was 92.5%. The success rate was higher in the malignancy group. In the cancer group, selective cordotomy (pain sensation denervated only in the painful region of the body) was achieved in 83%. In 12 cases, bilateral selective percutaneous cordotomy was successfully applied. Conclusion: In the treatment of intractable pain, CT-guided cordotomy is an option in specially selected cases with malignancy. In this study, anatomic and technical details of the procedure and the experience gained from treating 207 patients over a 20-year period are discussed.

Transient Repiratory Dysfunction after Percutaneous Cordotomy -A case report-

2005 ◽  
Vol 18 (2) ◽  
pp. 275
Author(s):  
Jun Seog Lee ◽  
Yoo Sik Sinn ◽  
Chan Hong Park
Keyword(s):  
Case Report ◽  
Percutaneous Cordotomy
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