Percutaneous cervical cordotomy for relief of intractable pain
THE treatment of intractable pain that is caused by metastatic disease or by a benign condition is frequently a frustrating endeavor. Surgical section of the anterolateral portion of the spinal cord has been used for many years to interrupt the pain pathways and render the patient insensitive to pain that could not be more specifically treated. However, many patients, especially those with metastatic disease, are unable to tolerate such surgery.
Percutaneous cervical cordotomy recently has been developed to spare the patient the necessity of undergoing surgical interruption of the pain pathways. In this procedure, a needle electrode, guided by means of roentgenography, is inserted into the anterolateral quadrant of the spinal cord in the cervical region, and an electric current forms a lesion that interrupts the pain pathways. The pathways transmitting sensation for other sensory modalities, such as touch and proprioception, are not affected, nor are the pathways involved with motor function.
As originally devised by Mullan and associates,1 and reported in 1963, a needle was introduced from the lateral direction between the posterior arch of the first and the lamina of the second cervical vertebrae. Originally, the needle was introduced somewhat obliquely and the lesion was made by the application of radioactive material. However, the technic was later modified by Rosomoff and associates2 so that the needle electrode is introduced in the coronal plane and the lesion is made by the application of a radiofrequency current.
The procedure is performed under local anesthesia. The patient is placed in . . .