Indications For Percutaneous Cordotomy

Cordotomy is the preferred method if the surgeon is certain that the patient's intractable pain is transmitted in the LST. The best candidates for cordotomy are patients with unilateral somatic cancer pain and compression of the plexus, roots, or nerves [19]. Tasker defined two types of pain as indications for cordotomy: one is intermittent, neuralgia-like, shooting pain into the legs associated with a spinal cord injury typically at the thoracolumbar level; the other type is evoked pain—allodynia or hyperpathia—associated with neuropathic pain syndromes that arise from peripheral neurological lesions [19,20].

The indications for open and PC involve the same types of patients. Percutaneous cordotomy is generally preferable, but open cordotomy is recommended if the necessary equipment is not available or the surgeon's experience is inadequate to perform PC. If the patient has anomalies or other diseases of the upper cervical region, open cordotomy is again recommended [19,20]. Contrary to popular opinion, unilateral upper body pain (secondary to lung carcinoma, mesothelioma, or Pancoast tumors) and bilateral somatic intractable pain in the lower body and extremities can be controlled by CT-guided, unilateral, or bilateral selective cordotomy [11,12]. Nowadays, with the help of imaging techniques and the recent contribution of electrode technology, cordotomy can be performed safely and effectively. Thus, CT-guided PC should be considered the treatment of choice even before morphine therapy [11,12]. Cordotomy is contraindicated in patients with severe pulmonary dysfunction, those who are unable to stay in a supine position for 30 to 40 minutes, and those whose partial oxygen saturation is less than 80%. For patients with bilateral intractable pain of the chest and arms, bilateral high cervical cordotomy is not recommended by the author.

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