Impedance Measuring Device for Detection of Penetration of the Spinal Cord in Anterior Percutaneous Cervical Cordotomy

The management of severe, medically intractable pain is a significant challenge for neurosurgeons and pain management physicians. An existing technique that can effectively alleviate contralateral chronic pain is cordotomy, interruption of the lateral spinothalamic tract of the spinal cord. Since 1912, cordotomy has evolved from a relatively morbid open surgical procedure to a percutaneous radiofrequency procedure with low morbidity. However, since cordotomy is utilized primarily in cancer pain patients, long-term patient follow-up is rare, and the potential duration of analgesia following cordotomy is not known. Here we describe a case with a 41-year follow-up of percutaneous cordotomy for noncancer pain that resulted in over 35 years of complete analgesia, the longest recorded in the literature to date. This case demonstrates that percutaneous cordotomy can provide long-lasting, complete analgesia in some patients and merits continuation as a part of the neurosurgical arsenal of pain therapies.

Section: Discussionmentioning

confidence: 99%

Four-Decade Maintenance of Analgesia with Percutaneous Cordotomy

Collins¹,

Taren²,

Patil³

2012

“…Despite the popularization of percutaneous procedures [8] a great er accuracy was expected using stereotactic apparatus and deep elec trode recording [4], but there have been few communications demon strating less respiratory morbidity with the use of these relatively new means of treatment [11]. We present here data concerning changes in respiration occurring in three groups of patients undergoing high cer vical stereotactic surgery.…”

Section: Introductionmentioning

confidence: 98%

Respiratory Changes after Stereotactic High Cervical Cord Lesions for Pain

Lema¹,

Hitchcock²

1986

Stereotactic cordotomy affected forced expiratory volume in 1 sec (FEV₁) less than open cordotomy, but 11 of 15 patients had some effect on respiratory functions. Central cord lesions produced a small (9%) fall in values. Of 10 patients with trigeminal lesions 7 had no charge in respiratory function, but 2 had reduction of more than 50% associated with transient extremity paresis, attributed to injury to a corticospinal pathway to respiratory neurones.

“…According to the determined diametral measurements of the anteroposterior and lateral dimensions of the cord, the electrode tip is adjusted to penetrate the cord to the desired length (2-3 mm). After successful penetration of the spinal cord, confi rmed by an impedance jump to greater than 1,000 ⍀ [12] (impedance is less than 400 ⍀ in the CSF and greater than 1,000 ⍀ inside the spinal cord), electrophysiological testing [13] is performed.…”

Section: Methodsmentioning

confidence: 99%

Percutaneous Computed Tomography-Guided Transdiscal Low Cervical Cordotomy for Cancer Pain as a Method to Avoid Sleep Apnea

Raslan

2005

Objective: Study of percutaneous computed tomography (CT)-guided transdiscal low cervical cordotomy undertaken to treat pain in cancer patients. Methods: At the Department of Neurosurgery, Ain Shams University, Cairo, Egypt, 8 cancer pain patients, with either impaired pulmonary function or a previous cordotomy on an opposite side (sleep apnea was a feared complication) that prevented the possibility of undergoing a C_1–2 cordotomy, underwent a percutaneous CT-guided transdiscal low cervical cordotomy (C_4–5 or C_5–6) to treat cancer pain. Results: Seven patients experienced initial improvement. One patient re-experienced pain within 2 weeks and 1 patient experienced no pain relief. In 6 patients in whom the cordotomy procedure was completed, satisfactory or complete pain relief, throughout a 6-month follow-up period was reported. In contrast, in 2 patients in whom the cordotomy was not completed there was no persistent pain relief. Conclusion: Percutaneous CT-guided cordotomy remains a successful procedure to control pain in cancer patients, and is an affordable viable option under circumstances where economic disadvantage is an overriding determinate.