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

Abstract

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.

Cordotomy in mesothelioma-related pain: a systematic review

“…All studies were in secondary care settings. Five of the included studies were prospective14 17 23 24 (Sharma, unpublished data, 2011), three were retrospective22 25 (Antrobus, unpublished data, 2011) and one study may have been prospective, but this remains unclear 21. Two studies were unpublished (Antrobus, unpublished data, 2011, Sharma, unpublished data, 2011) (see online supplementary table S1).…”

“…Five used 11 point scales (patient self-report measures of pain ranging from no pain=0 to worst pain ever=10). Three of these reported a median pre-procedure pain intensity score which ranged from 7.5 to 9 14 24 25. The other two reported a score for the maximum and average pain experienced in a pre-procedure interval: Antrobus (2011) noted pain during the last week (worst: median=10, average: median=7) and Sharma (2011) reported pain in last 24 h (maximum: mean=8.71, average: mean=6.76).…”

“…Sedation in small doses was used in some of the studies. Three studies used CT guidance 14 23 24. Raslan(b), in his 2005 study, employed an anterior transdiscal approach at C4/5 or C5/6 level using water-soluble contrast 24.…”

“…Three studies used CT guidance 14 23 24. Raslan(b), in his 2005 study, employed an anterior transdiscal approach at C4/5 or C5/6 level using water-soluble contrast 24. Four studies reported on staff performing or assisting in the procedure14 24 (Antrobus, unpublished data, 2011, Sharma, unpublished data, 2011).…”

“…Raslan(b), in his 2005 study, employed an anterior transdiscal approach at C4/5 or C5/6 level using water-soluble contrast 24. Four studies reported on staff performing or assisting in the procedure14 24 (Antrobus, unpublished data, 2011, Sharma, unpublished data, 2011). All procedures were performed by a pain specialist assisted by others, including a radiographer and theatre support staff (Antrobus, unpublished data, 2011, Sharma, unpublished data, 2011).…”