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 temperatureperception. 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.
Cordotomy is performed as for patients with severe intractable pain, usually but not always due to cancer. Being irreversible and relatively invasive, cordotomy is used exclusively for pain where treatment to level 3 of the World Health Organizationpain ladder (i.e., use of major opiates such as morphine) has proved inadequate. Cordotomy is especially indicated for pain due to asbestos-related cancers such as pleural and peritoneal mesothelioma.
Open cordotomy, which requires a laminectomy (removal of part of one or more vertebrae), takes place under general anaesthetic and has a longer recovery time and a higher risk of side-effects including permanent weakness. However, it is still sometimes used where percutaneous cordotomy is unfeasible, especially in children or other patients who are unable to co-operate. In open cordotomy, a thoracic approach is normally used so that the spinal cord tracts controlling the breathing muscles are not put at risk.
Adverse effectsedit
Cordotomy can be highly effective in relieving pain, but there are significant side effects. These include dysesthesia (abnormal sensation),[1] urinary retention and (for bilateral cervical cordotomy) apnea during sleep (acquired central hypoventilation syndrome) caused by inadvertent division of the reticulospinal tracts.[2]
Historyedit
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 painedit
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 intrathecal pump (a syringe driver delivering medication into the space around the spinal cord) administering local anaesthetics and/or opiates[8]
Referencesedit
^Mann, Michael. . 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
^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 linksedit
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
January 01, 1970
cordotomy, chordotomy, surgical, procedure, that, disables, selected, pain, conducting, tracts, spinal, cord, order, achieve, loss, pain, temperature, perception, this, procedure, commonly, performed, patients, experiencing, severe, pain, cancer, other, incura. 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 CordotomyICD 9 CM03 2MeSHD002818 edit on Wikidata Contents 1 Indications 2 Procedure 3 Adverse effects 4 History 5 Alternative surgical procedures for pain 6 References 7 External linksIndications editCordotomy is performed as for patients with severe intractable pain usually but not always due to cancer Being irreversible and relatively invasive cordotomy is used exclusively for pain where treatment to level 3 of the World Health Organization pain ladder i e use of major opiates such as morphine has proved inadequate Cordotomy is especially indicated for pain due to asbestos related cancers such as pleural and peritoneal mesothelioma Procedure editMost cordotomies are now performed percutaneously with fluoroscopic or CT guidance while the patient is awake under local anesthesia The spinothalamic tract is normally divided at the level C1 C2 Open cordotomy which requires a laminectomy removal of part of one or more vertebrae takes place under general anaesthetic and has a longer recovery time and a higher risk of side effects including permanent weakness However it is still sometimes used where percutaneous cordotomy is unfeasible especially in children or other patients who are unable to co operate In open cordotomy a thoracic approach is normally used so that the spinal cord tracts controlling the breathing muscles are not put at risk Adverse effects editCordotomy can be highly effective in relieving pain but there are significant side effects These include dysesthesia abnormal sensation 1 urinary retention and for bilateral cervical cordotomy apnea during sleep acquired central hypoventilation syndrome caused by inadvertent division of the reticulospinal tracts 2 History editCordotomy 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 editA 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 intrathecal pump a syringe driver delivering medication into the space around the spinal cord administering local anaesthetics and or opiates 8 References edit 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 2006External links editAl 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 Retrieved from https en wikipedia org w index php title Cordotomy amp oldid 1191433748, wikipedia, wiki, book, books, library,
