Cordotomy
Cordotomy | |
---|---|
ICD-9-CM | 03.2 |
MeSH | D002818 |
Cordotomy (or chordotomy) is a surgical procedure that disables selected pain-conducting tracts in the spinal cord, in order to achieve loss of pain and temperature perception. This procedure is commonly performed on patients experiencing severe pain due to cancer or other incurable diseases. Anterolateral cordotomy is effective for relieving unilateral, somatic pain while bilateral cordotomies may be required for visceral or bilateral pain.
Indications
Cordotomy is performed as for patients with severe intractable pain, usually but not always due to
Procedure
Most cordotomies are now performed
Open cordotomy, which requires a
Adverse effects
Cordotomy can be highly effective in relieving pain, but there are significant side effects. These include
History
Cordotomy was first performed in 1912 by the American Neurosurgeons, William Gibson Spiller (1863–1940) and Edward Martin (1859–1938).[3] Due to the surgical risks, it remained a rare procedure until the percutaneous technique was developed in 1965.[4] During the 1990s the procedure became less widely used, partly because medical pain-control options had improved, and partly due to concern about side-effects. Nevertheless, it is still considered an effective treatment for severe pain.
Alternative surgical procedures for pain
A number of alternative surgical procedures have evolved in the 20th century. These include:
Commissural myelotomy, for bilateral pain arising from pelvic or abdominal malignancies [5]
Punctate or limited midline myelotomy for pelvic and abdominal visceral pain,[6][7]
Other options for medically intractable pain which do not involve open surgery include implantation of an
References
- ^ Mann, Michael. "Somesthesia - Central Mechanisms". The Nervous System in Action. Archived from the original on 12 June 2011. Retrieved 30 May 2011.
- ^ Tranmer B, Tucker W, Bilbao J. Sleep apnea following percutaneous cervical cordotomy. Can J Neurol Sci, 14(3):262-7, 1987
- ^ Spiller W, Martin E. The treatment of persistent pain of organic origin in the lower part of the body by division of the anterolateral column of the spinal cord. JAMA, 58(1):489-90, 1912
- ^ Mullan S, Hekmatpanah J, Dobben G, Beckman F. Percutaneous, intramedullary cordotomy utilizing the unipolar anodal electrolytic lesion. J Neurosurg, 22(6):548-53, 1965
- ^ Viswanathan A, Burton AW, Rekito A, McCutchean IE, "Commissural myelotomy in the treatment of intractable visceral pain: technique and outcomes", Stereotactic and Functional Neurosurgery, 88(6):374-82, 2010
- ^ Hong D, Andren-Sandberg A, "Punctate midline myelotomy: a minimally invasive procedure for the treatment of pain in inextirpable abdominal and pelvic cancer", Journal of Pain Symptom Management, 33(1):99-109, 2007
- ^ Gildenberg PL, Hirshberg RM, "Limited myelotomy for the treatment of intractable cancer pain", Journal of Neurology, Neurosurgery, and Psychiatry, 47(1):94-6, 1984
- ^ Do Ouro S, Esteban S, Sibercerva U, Whittenberg B, Portenov R, Cruciani RA, "Safety and tolerability of high doses of intrathecal fentanyl for the treatment of chronic pain", Journal of Opioid Management, 2(6):365-8, 2006
External links
- Al-Chaer ED et al. A role for the dorsal column in nociceptive visceral input into the thalamus of primates. J Neurophysiol. 1998 Jun;79(6):3143-50
- Laboratory of Elie D. Al-Chaer for the Study of Pain
- A CBS HealthWatch: Breakthrough In Battling Back Pain, New Procedure Just 8 Minutes To Change Your Life